OF  THE 


fner*- 

-A 


ETH 


BY 


EUGENE  S.  TALBOT,  M.  D.,  D.  D.  S. 


UNC 

HEALTH  SCIENCES  LIBRARY 


The  Sheldon  Peck  Collection 
on  the  History  of  Orthodontics 
and  Dental  Medicine 

Gift  of 

Sheldon  Peck,  DDS  1966 

and 

Leena  Peck,  DMD 


QUIZ  COMPEND 

ON 

IRREGULARITIES 

OF  THE 

TEETH 


TALBOT 


QUIZ  COMPEND 

ON 

\ 

IRREGULARITIES 

OF  THE 

TEETH 

\ 


BY 

EUGENE  S.  TALBOT,  M.D.,  D.D.S. 

Professor  of  Dental  and  Oral  Surgery,  Northwestern  University, 

Woman’s  Medical  School 


FIRST  EDITION 


CHICAGO 

E.  M.  Clay  &  Co. 
103  State  Street 


1901 


Entered  according  to  Act  of  Congress  in  the  year  1901,  by 

EUGENE  S  TALBOT, 

In  the  Office  of  the  Librarian  of  Congress,  at  Washington,  D.  C. 


I 


PREFACE 

> 

^THE  object  of  this  work  is  not  intended 
*  to  take  the  place  of  the  larger  and 
more  complete  works,  but  to  be  used  as  a 
primer  and  reference  for  advanced  students. 
The  quiz  compend  principle  has  answered 
so  excellently  in  medicine  as  to  entail  a. 
similar  system  for  dental  students. 

Etiology  has  been  discussed  at  length 
since  its  knowledge  must  precede  and 
determine  the  treatment.  Questions  and 
answers  generally  prove  suggestive  to  the 
teacher  as  to  new  lines  of  study. 

In  the  treatment  of  irregularities  of  the 
teeth,  all  forces  may  be  applied  individually 
to  a  given  case.  The  author  has  inten¬ 
tionally  avoided  a  discussion  of  special  treat¬ 
ment  since  every  teacher  has  of  necessity 
his  own  methods  of  operation. 


CONTENTS 


Chapter.  Page. 

I.  History .  9 

II.  Heredity . 29 

III.  Congenital  Factors  and  Maternal  Impressions  ...  43 

IV.  Post-Natal  Skull  and  Jaw  Development  and 

Periods  of  Stress . .- .  49 

V.  Development  of  the  Cranium  and  Face .  63 

VI.  Development  of  the  Jaws  . 77 

/  VII.  Development  of  the  Alveolar  Process .  85 

VIII.  Development  of  the  Vault .  89 

IX.  Development  of  the  Peridental  Membrane .  97 

X.  Development  of  the  Teeth .  101 

XI.  Social  Consanguinity,  Near-Kin,  Early  and  Late 

Marriage .  105' 

XII.  Environment,  Climate,  Soil  and  Food .  115 

XIII.  Race  Admixture .  129 

XIV.  Constitutional  Disorders .  137 

XV.  Intellectual  and  Moral  Defects .  147 

XVI.  Inter-Operations  of  Causes  and  Predispositions. .  149 

XVII.  Developmental  Neuroses  of  the  Face .  157 

XVIII.  Developmental  Neuroses  of  the  Nose  and  Interior 

Facial  Bones . 163 

XIX.  Developmental  Neuroses  of  the  Eye .  177 

XX.  Developmental  Neuroses  of  the  Bones  of  the  Ear,  185 

XXI.  Developmental  Neuroses  of  the  Jaws  of  the  Seem¬ 
ingly  Normal .  187 

XXII.  Developmental  Neuroses  of  Maxillary  Bones .  189 

XXIII.  Developmental  Neuroses  of  the  Vault .  195 

XXIV.  Developmental  Neuroses  of  the  Palate .  209 

XXV.  Developmental  Neuroses  in  Teeth  Position . 219 

XXVI.  Local  Causes  of  Teeth  Irregularities — Upper  Jaw,  231 

XXVII.  Local  Causes  of  Teeth  Irregularities — Lower  Jaw,  241 

XXVIII.  Local  Causes  of  Teeth  Irregularities— Finger- 

Sucking  .  249 

XXIX.  The  Degenerate  Teeth .  253 

XXX.  Surgical  Diagnosis .  269 

XXXI.  Physiologic  and  Pathologic  Changes .  293 

XXXII.  Surgical  Correction .  303 


7 


QUIZ  COMPEND 

ON 

Irregularities  of  the  Teeth 


CHAPTER  I. 


HISTORY. 

Q.  Is  practice  of  dentistry  ancient? 

A.  It  was  a  very  early  specialty  of  medicine. 
According  to  Sayce  and  others,  the  Assyrians  early 
practiced  tooth  filling  with  gold,  and  allied  proced¬ 
ures. 

Q.  What  was  the  folklore  belief  of  dental  decay? 

A.  That  it  was  due  to  a  worm  in  the  tooth. 

Q.  Did  the  Assyrians  reach  a  very  high  level  in 
medicine? 

A.  They  did  not  reach  a  higher  level  in  medicine 
and  surgery  than  that  of  the  Chinese  of  to-day,  who 
are  presumably  the  inheritors  of  their  science. 

Q.  What  country  had  attained  a  relatively  high 
status  at  this  early  period? 

A.  In  Egypt  nearly  every  branch  of  medicine  had 
attained  a  high  standard  at  the  time  of  Herodotus. 

Q.  Do  records  show  that  dentistry  was  practiced 
earlier  than  this  period? 

A.  As  shown  by  the  Eber’s  papyrus,  dentistry  was 
a  differentiated  specialty  of  medicine  much  earlier. 

9 


10 


QUIZ  COMPEND 


Q.  When  was  gold  used? 

A.  It  was  employed  by  the  Egyptians  for  filling 
teeth  as  well  as  for  correction  of  irregularities. 

Q.  What  evidence  is  there  for  this? 

A.  Mummies  are  found  containing  teeth  held  in 
place  and  diiected  by  gold  or  silver  wires  or  plates. 

Q.  What  other  peoples  practiced  dentistry  in  earlv 
times? 

A.  In  Hindoo  civilization,  dentistry  early  reached 
a  high  status  as  a  specialty  of  medicine.  Such  civiliza¬ 
tion  fell  later  into  decay  when  the  folklore  notion  of 

disease  due  to  the  worm  in  the  tooth  resumed  its  promi¬ 
nence. 

Q.  Was  Hippocrates  particular  in  regard  to  dental 
operations?  1  . 

A.  Caution  was  advanced  by  him  in  extraction  of 
teeth  and  preserving  them. 

Q.  What  other  important  point  was  he  critical 
about? 

A.  He  attacked  principally  the  fetichic  origin  of 
disease. 

Q.  What  did  this  notion  lead  him  to? 

A.  As  this  played  a  large  part  in  compelling 
unnecessary  extraction  of  teeth,  he  naturally  was  led 

to  describe  the  character  of  teeth  and  the  indication 
for  their  extraction. 

Q.  What  important  scientist  followed  him,  and 
what  great  lesson  did  he  teach? 

A.  One  hundred  and  sixty  years  after  him  Erasis- 
tratus  deposited  in  the  temple  of  Apollo  at  Delphos  an 
odontogogue  or  leaden  tooth  forceps,  intimating  that 
only  teeth  should  be  drawn  which  were  loose  enough 
to  be  extracted  with  this  instrument. 


ON  IRREGULARITIES  OF  THE  TEETH. 


11 


Q.  What  was  the  lesson  to  teach? 

A.  This  (an  ex-voto  offering  for  recovery  from 
disease)  was  probably  intended  by  Erasistratus  as  a 
popular  lesson  against  too  early  extraction  of  teeth. 

Q.  Were  the  Romans  influenced  by  this? 

A.  So  far  as  dentistry  is  concerned,  the  Romans 
were  as  much  influenced  by  Etruscan  as  by  Greek  cul¬ 
ture,  although  the  last  had  a  very  early  influence. 

Q.  Were  the  Etruscans  versed  in  dentistry? 

A.  They  practiced  dental  procedures  resembling, 
but  more  complete  even  than  those  of  Greece. 

Q.  Did  the  Romans  early  practice  dentistry? 

A.  In  Rome  artificial  dentures,  evidently  modeled 
on  Etruscan  types,  were  made  ere  the  period  of  the 
laws  of  the  “Twelve  Tables.’’ 

Q.  When  did  Celsus  practice? 

A.  He  practiced  A.  D.  30.  He  was  considered 
rather  rough  in  his  surgical  operations. 

Q.  When  did  Galen  practice,  and  what  important 
name  did  he  give  to  some  of  the  teeth? 

A.  Galen  practiced  150  A.  D.  ■  He  gave  the  canine 
teeth  the  present  popular  term,  eye  teeth,  because  he 
believed  they  were  supplied  by  the  optic  nerve. 

Q.  What  great  medical  school  developed  in  the 
seventh  century? 

A.  The  Greek,  Etruscan,  Roman,  and  Arabian 
culture  met  at  the  famous  school  of  Salernum,  South¬ 
ern  Italy,  which  opened  700  A.  D. 

Q.  Where  and  when  did  dentistry  advance? 

A.  Under  the  influence  of  this  school,  dentistry 
was  practiced  more  by  surgeons  and  physicians, \ 
whereas  it  had  been  previously  largely  confined  to 
charlatans. 


12 


QUIZ  COMPEND 


Q.  When  was  the  antrum  described? 

A.  About  the  middle  of  the  thirteenth  century,  by 
Bruno  of  Langoburo,  who  mentioned  various  opera¬ 
tions  upon  the  teeth  and  antrum  nearly  four  centuries 
before  Highmore.  s 

Q.  When  was  the  earliest  European  attempt  to  cor¬ 
rect  irregularities  of  the  teeth  made? 

A.  About  the  fifteenth  century  Giovanni  d’Arcoli 
filled  teeth  with  gold  and  made  attempts  to  regulate 
them. 

Q.  Where  did  Shakespeare  obtain  his  observations 
in  regard  to  the  teeth? 

A.  From  the  famous  anatomy  of  Helkiah  Crooke, 
published  in  1618. 

Q.  When  and  by  whom  was  thp  first  French  work 
published? 

A.  A  work  called  “Le  Chirurgien  Dentiste”  was 
published  by  Fauchard  in  1728. 

Q.  Who  wrote  a  similar  work  in  French? 

A.  Aeubzi,  of  Lyons. 

Q.  Who  made  the  earliest  great  impression  upon 
the  profession? 

A.  Crooke,  who  in  discussing  second  dentition, 
remarks  that  “The  shearing  (i.  e.,  incisors)  teeth, 
when  they  do  break  forth,  do  thrust  the  first  shearers 
out  before  them  and  issue  betwixt  the  first  two,  the 
second  and  the  dog  tooth  that  is  next  unto  them. 
But  if  the  former  teeth  will  not  fali  or  be  not  pulled 
out,  or  if  the  latter  issue  before  the  first  fall,  then  the 
latter  make  their  way  through  new  sockets  and  turn 
in  the  upper  jaw  outward,  in  the  lower  jaw  inward,  so 
that  there  seemed  to  arise  a  new  row  of  teeth,  and  this 
hath  deceived  many  historians  and  anatomists  also.” 


ON  IRREGULARITIES  OF  THE  TEETH. 


13 


Q.  Who  first  mentioned  supernumerary  teeth? 

A.  Barth  Ruspini,  a  century  and  a  quarter  after 
Crooke,  claimed  that  all  teeth  which  exceed  thirty-two 
may  be  regarded  as  supernumerary.  In  his  opinion 
irregularities  of  the  canines  and  incisors  were  attribut¬ 
able  to  extreme  narrowness  of  the  jaws. 

Q.  Half  a  century  later  what  did  Robert  Blake 
write? 

A.  He  describes  supernumerary  and  inverted  teeth. 

Q.  Three  decades  after  what  did  Joseph  Harris  and 
Joseph  Winckworth  remark? 

A.  That  irregularities  were  due  to  supernumerary 
teeth. 

Q.  What  causes  attributable  to  irregularities,  then 
advanced,  are  still  defended? 

A.  Among  these  causes  (still  in  considerable  favor 
among  .dentists,  laryngologists  and  general  practition¬ 
ers)  may  be  mentioned,  thumb-sucking,  mouth  breath¬ 
ing  and  enlarged  tonsils. 

Q.  What  theory  was  advanced  by  J.  Imrie,  six  and 
one-half  decades  ago? 

A.  That  irregularity  is  due  to  want  of  development 
of  the  jaw  bones,  intemperance  of  various  kinds,  com¬ 
bined  with  artificial  modes  of  living  induced  by  civili¬ 
zation,  and  sudden  change  from  heat  and  cold  to  which 
the  teeth  are  subject.  Rabbit  mouth  is  due  to  keep¬ 
ing  the  thumb  in  the  mouth  for  hours  after  going  to 
sleep.  Underhung  jaw  is  due  to  sucking  the  tongue 
which  throws  the  under  jaw  from  its  articulation. 

Q.  What  does  he  advise  about  the  extraction  of 
teeth? 

A.  A  similar  state  of  the  teeth  and  jaws  is  induced 
when  attempts  are  made  by  the  inexperienced  to 


14 


QUIZ  COMPEND 


regulate  them  by  extraction  of  teeth  in  the  upper  jaw 
and  neglecting  to  remove  an  equal  number  of  the 
lower. 

Q.  What  was  J.  Lefoulon’s  opinion? 

A.  That  the  most  frequent  cause  of  dental  irreg¬ 
ularities  is  the  neglect  of  proper  supervision  of  the 
second  dentition. 

Q.  What  did  Thomas  Ballard  claim? 

A.  That  serrated  teeth  and  projecting  jaws  were 
the  result  of  fruitless  sucking. 

Q.  What  was  Stockton’s  opinion? 

A.  That  the  cause  may  be  found  in  the  form  of  the 
palate.  Irregularity  of  position  is  almost  exclusively 
confined  to  the  five  anterior  teeth  on  each  side  of  the 
median  line  brought  about  by  the  tongue  upon  the 
hard  palate  in  sucking  or  mastication. 

Q.  What  were  Nasmyth’s  views? 

A.  That  the  projecting  upper  jaw  was  due  to  thumb 
and  finger  sucking.  But  when  both  were  involved 
that  it  was  due  to  arrest  of  development  in  the  jaw 
where  the  expansion  of  the  jaw  was  deficient. 

Q.  What  changes'occurred  during  the  next  twenty- 
five  or  thirty  years? 

A.  The  opinion  as  to  the  influence  of  thumb-suck¬ 
ing  continued  to  grow. 

Q.  What  opinions  were  prevalent  in  1873? 

A.  A.  A.  de  Lessert,  Thomas  Salter  and  J.  W. 
White  believed  that  thumb-sucking  was  the  principal 
cause. 

O.  How  did  Francis  Fox  view  irregularities? 

A.  That  the  want  of  proportion  in  size  of  the  teeth 
and  jaw  bones, or  prolonged  retention  of  the  temporary 
teeth,  supernumerary  teeth,  the  habit  of  thumb-suck- 


ON  IRREGULARITIES  OF  THE  TEETH. 


15 


ing,  undue  pressure  from  a  hypertrophied  tongue,  and 
heredity  were  the  causes. 

Q.  What  effect  did  Helkiah  Crooke’s  summary 
have? 

A.  His  views  influenced  investigators  about  a  cen¬ 
tury  and  a  half  afterwards.  Thomas  Berdmore 
claimed  that  the  presence  of  supernumerary  teeth  or 
of  a  double  row  of  teeth  is  due  to  the  fact  that  the  milk 
teeth  are  never  shed,  notwithstanding  the  fact  that  the 
permanent  teeth  appear. 

Q.  What  did  Joseph  Fox  claim  as  causes  of  irreg¬ 
ularities  of  the  teeth? 

A.  That  the  most  frequent  cause  is  a  want  of  sim¬ 
ultaneous  action  between  the  increase  of  the  perma¬ 
nent  teeth  and  the  decrease  of  the  temporary  ones  by 
the  absorption  of  their  fangs,  most  commonly  occa¬ 
sioned  by  the  resistance  of  the  nearest  temporary 
teeth. 

Q.  What  did  Joseph  Murphy  believe? 

A.  That  irregularity  is  due  chiefly  to  the  first  teeth 
not  having  been  shed  in  time. 

Q.  What  are  Benjamin  James  and  Parmly’s  views? 

A.  They  agree  with  Murphy.  Parmly  further  says 
that  when  the  permanent  teeth  are  large  and  growth 
of  the  jaw  does  not  proceed  in  a  corresponding  propor¬ 
tion,  they  are  found  crowded,  and  overlap  each  other. 

Q.  What  did  G.  White  find? 

A.  That  irregularities  of  the  teeth  are  mostly  occa¬ 
sioned  by  the  pressure  of  the  temporary  upon  the  per¬ 
manent,  throwing  them  in  the  wrong  direction. 

Q.  What  are  the  views  of  S.  S.  Fitch? 

A.  Similar  to  those  of  Joseph  Fox. 

Q.  What  is  the  opinion  of  J.  B.  Garriot? 


16 


QUIZ  COMPEND 


A.  That  the  deciduous  teeth,  by  their  pressure,  often 
prevent  the  permanent  teeth  from  arranging  them¬ 
selves  in  their  proper  positions. 

Q.  What  did  John  Hunter  advance  as  a  cause? 

A.  That  the  jaws  grow  at  the  posterior  edges,  and 
that  an  irregularity  is  often  due  to  the  ten  anterior 
permanent  teeth  being  larger  than  the  ten  anterior 
temporary  teeth,  while  the  corresponding  part  of  the 
jaw  is  of  the  same  size;  therefore  in  such  cases  the 
second  set  is  obliged  to  stand  very  irregular. 

Q.  From  observation  made  upon  young  pigs,  at 
what  conclusions  did  G.  M.  Humphrey  arrive? 

A.  That  there  is  no  interstitial  growth.  The  five 
permanent  teeth  occupy  exactly  the  same  position 
throughout  life  and  all  conditional  teeth  are  added  to 
the  hind  end  of  the  jaw.  This  hind  end  is  enlarged 
by  the  absorption  of  the  anterior  coronoid  edge  and 
the  deposition  on  the  posterior  edge  where  the  molars 
are  first  formed  they  are  under  the  coronoid  process 
and  are  frequently  exposed. 

Q.  What  did  L.  Koecker  claim  in  1826? 

A.  That  the  deformity  which  consists  in  shutting 
the  under  incisor  and  cuspidati  over  the  upper,  has 
been  produced  by  the  injudicious  extraction  of  some 
of  the  teeth  of  the  upper  without  taking  proper  care 
to  secure  due  proportion  between  the  upper  and  under 
jaw. 

Q.  What  did  Thomas  Bell  think? 

A.  That  the  most  usual  cause  of  permanent  irregu¬ 
larity  is  the  actual  want  of  sufficient  room  in  the  jaw 
for  the  ultimate  regular  arrangement  of  the  teeth. 

Q.  What  is  Joseph  Scott’s  opinion? 

A.  Irregularity  arises  from,  first,  a  natural  want  of 


ON  IRREGULARITIES  OF  THE  TEETH.  17 

sufficient  expansion  in  the  jawbone  at  the  time  of 
their  protrusion ;  second,  from  not  extracting  the  tem¬ 
porary  teeth  at  the  proper  time;  third,  from  too  early 
extraction  of  the  temporary  teeth;  fourth,  from  super¬ 
numerary  teeth. 

Q.  What  did  John  Nicholls  find? 

A.  That  the  deformity  may  be  due  to  too  long  per¬ 
sistence  of  the  temporary  teeth,  or  arises  from  some 
malnutrition  of  the  teeth  or  jaws,  entirely  beyond  the 
previous  control  of  the  dentist. 

Q.  What  are  the  views  of  M.  Maclean? 

A.  That  expansion  of  the  jaw  is  prevented  by 
premature  extraction  of  the  temporary  teeth. 

Q.  What  did  E.  E.  Spooner  find? 

A.  That  the  first  and  most  frequent  cause  of  irreg¬ 
ularity  is  a  want  of  simultaneous  action  between  the 
protrusion  of  the  permanent  teeth  and  absorption  of 
the  fangs  of  the  temporary.  The  second  cause  is  a 
narrowness  of  the  maxillary  arch, or  a  want  of  propor¬ 
tion  between  the  extent  of  it  and  the  size  of  the  teeth. 

O.  What  theories  did  William  Thornton  advance? 

A.  That  irregularities  of  the  teeth  proceed  from 
three  causes:  First,  from  natural  want  of  sufficient 
expansion  in  the  jawbone  at  the  time  of  the  protrusion 
of  the  teeth,  second,  non-extraction  of  temporary  teeth 
at  the  proper  time;  third,  too  early  an  extraction  of 
the  temporary. 

Q.  What  views  did  Mortimer  have? 

A.  That  irregularities  of  the  teeth  arise  from 
natural  and  accidental  causes.  Natural  causes  arise  from 
the  bad  conformation  of  the  jaw,  so  that  several  teeth 
are  over  each  other;  from  the  teeth  being  much 
larger  than  they  should  be;  from  coming  out  of  order 


18 


QUIZ  COMPEND 


and  place;  from  teeth  growing  out  of  the  plate  or  pro¬ 
jecting  out  of  the  mouth.  Accidental  causes  arise  from 
neglect  or  ignorance  in  removing  milk  teeth  too  soon, 
when  the  second  teeth  take  a  direction  inward  or 
outward  from  some  internal  came;  underhung  jaws 
arise  from  making  faces. 

Q.  What  theories  did  Charles  de  Loudes  advance? 

A.  That  irregularities  are  due  to  supernumerary 
teeth,  to  second  teeth  being  large  and  maxillary  arch 
too  narrow,  to  early  extraction,  to  too  long  persistence 
of  the  temporary  teeth,  to  shape  of  the  maxillary  arch, 
and  to  heredity,  where  the  child  inherits  the  jaw  of  one 
parent  and  the  teeth  of  another. 

Q.  What  views  did  Samuel  Ghimes  suggest? 

A.  He  spoke  of  the  underhung  jaw  being  due  to- 
the  upper  incisors  extending  inwards,  and  in  closing 
the  mouth,  they  come  in  contact  with  the  lower.  This 
makes  the  child  incline  to  protrude  the  lower  jaw, 
which  finally  becomes  habitual  and  promotes  the  in¬ 
crease  in  the  length  of  the  jaw  itself. 

Q.  To  what  does  Nessel  attribute  irregularities? 

A.  To  the  premature  extraction  of  the  temporary 
teeth.  The  alveoli  form  a  bone  scar  in  such  cases, 
which  constitutes  an  obstacle  to  the  advancement  of 
the  permanent  teeth.  In  .consequence,  the  permanent 
teeth  come  before  the  jaw  is  sufficiently  expanded  to 
receive  them. 

Q.  Between  what  years  was  the  theory  of  mouth 
breathing  most  prevalent? 

A.  Between  i860  and  1880,  mouth  breathing,  espe¬ 
cially  during  sleep,  formed  a  prominently  discussed 
etiologic  factor. 

Q.  What  was  Tomes’  opinion? 


ON  IRREGULARITIES  OF  THE  TEETH. 


19 


A.  That  deformity  of  the  jaws  is  often  caused  by 
sleeping  with  the  mouth  open. 

Q.  What  did  Catlin,  the  ethnologist,  claim? 

A.  He  made  popular  propaganda  in  favor  of  nose 
breathing,  and  ascribed  many  diseases  to  keeping  the 
mouth  open.  Malformation  of  the  jaws  and  teeth 
were  due  to  keeping  the  mouth  open,  since  civilized 
man  is  the  only  animal  who  keeps  his  mouth  open 
during  sleep.  This  view  still  meets  with  much  favor 
among  dentists  and  laryngologists.  It  is,  however, 
losing  cast  with  paediatricians. 

Q.  Sixteen  years  after  Catlin,  what  views  were 
advanced  by  W.  Mathews? 

A.  Irregularities  were  attributable  to  enlarged 
tonsils,  which  necessitated  breathing  being  carried  on 
with  the  mouth  open.  They  were  also  due  to  heredity. 
The  maxilla  was  smaller  in  proportion  than  the  teeth, 
owing  to  the  lessened  work  of  the  jaws  and  teeth  among 
civilized  races.  Cross  breeding  played  an  important 
part,  as  did  thumb-sucking  and  lip-sucking;  retarded 
shedding  of  the  temporary  teeth  and  too  early  extrac¬ 
tion  of  the  first  permanent  molars.  The  congenital 
V-shaped  jaw  is  that  formed  where,  previous  to  birth, 
the  type  of  upper  maxillae  is  such  that  its  cornua  do 
not  diverge  posteriorly,  but  are  parallel.  As  that  por¬ 
tion  of  the  jaw  already  formed  never  changes  its  form, 
the  newly  added  parts  will  pass  off  in  divergent  lines, 
forming  an  angle  with  that  previously  existing  in  order 
to  correspond  with  the  increasing  width  of  the  base  of 
the  skull.  The  growing  tendency  exhibited  from  the 
time  of  Crooke  to  assign  constitutional  factors  import¬ 
ant  places  in  the  etiology  of  the  teeth  and  jaw  irregu¬ 
larities  is  noticeable  in  Mathews.  He,  while  laying 


20 


QUIZ  COMPEND 


stress  on  local  factors,  was  forced  to  recognize  the 
importance  of  constitutional  factors.  Constitutional 
factors  hence  early  began  to  assume  considerable 
importance.  John  Fuller,  while  attributing,  in  1810, 
irregularity  to  long  persistence  of  temporary  teeth, 
also  remarked  that  the  upper  jaw  is  often  too  small 
for  the  permanent  teeth,  this  condition  frequently 
resulting  in  its  irregularity. 

Q.  What  was  Sigmond’s  opinion? 

A.  That  irregularities  are  due  to  natural  and  acci¬ 
dental  causes.  Causes  are  natural,  (i)  when  they 
result  from  the  jaw  not  expanding  sufficiently  to  allow 
the  teeth  to  form  a  regular  circle;  (2)  when  they  are 
larger  than  the  ordinary  dimensions;  (3)  when  they 
do  not  appear  in  their  proper  order  and  place.  Causes 
are  accidental  when  due  to  negligence  or  improper 
treatment  at  the  time  of  growth. 

Q.  What  views  did  Andrew  Clarke  advance? 

A.  That  irregularity  of  the  teeth  is  occasioned  by 
want  of  room  in  the  jaw  and  not  from  any  effect  that 
the  first  set  of  teeth  may  produce  upon  them, is  evident 
from  the  fact  that  in  .all  cases  of  irregularity,  there  is 
not  room  to  admit  of  placing  the  teeth  properly. 

Q.  What  were  those  of  J.  P.  Clarke? 

A.  That  irregularity  may  arise  from  too  premature 
extraction  of  temporary  teeth.  Disproportion 
between  the  teeth  and  jaws  may  be  occasioned  by  a 
natural  conformation  of  the  parts, or  may  be  the  effect 
of  unnoticed  accident.  For  we  seldom  found  any  such 
disproportion  and  consequent  irregularity  in  the  teeth 
of  men  and  animals  in  a  wild  state. 

Q.  What  was  William  Robertson’s  hypothesis? 

A.  That  deformity  is  due  to  inheritance  of  the  CQn- 


ON  IRREGULARITIES  OF  THE  TEETH. 


21 


tracted  jaw  of  one  parent  and  the  large  teeth  of  the 
other. 

Q.  What  did  David  W.  Jobson  suggest? 

A.  That  irregularity  is  due  to  smallness  of  the 
maxillary  arch  and  the  great  size  of  the  permanent 
teeth,  and  to  their  situation,  part  on  the  inner  and  of 
others  on  outer  side  of  permanent  teeth. 

Q.  What  was  John  Malian’s  theory? 

A.  That  the  adult  teeth  being  larger  as  well  as 
more  numerous  than  the  milk  teeth,  it  is  obvious  that 
they  require  a  great  deal  more  room,  and  when  the 
absorption  of  the  latter  does  not  progress  equally  with 
the  growth  of  the  former,  the  new  teeth  are  crowded 
up  and  are  apt  to  be  forced  out  of  their  natural  posi¬ 
tion  by  the  resistance  of  the  old.  Again,  if  the  per¬ 
manent  prove,  as  they  sometimes  do,  disproportionately 
large  in  comparison  with  their  predecessors,  the  jaw 
may  not  be  sufficiently  extended  to  admit  of  their 
being  arranged  in  order,  in  which  case  some  overlap 
the  others  and  considerable  deformity  is  occasioned. 

Q.  What  was  Maury’s  theory? 

A.  That  the  prominence  of  the  upper  jaw  is  due  to 
narrowness  of  the  arch;  recession  to  the  anterior 
teeth. 

O.  What  suggestion  did  C.  H.  Harris  make? 

A.  That  infringement  of  the  laws  of  growth  or 
disturbance  of  the  organs  of  the  face  or  head  may 
determine  improper  development  of  the  jaws  and  bad 
arrangement  of  the  teeth.  Irregularity  of  the  teeth 
is  due  to  narrowness  of  the  maxillary  arch  and  some¬ 
times  to  the  presence  of  the  temporary  teeth. 

Q.  What  does  W-  K.  Brideman  suggest? 

A.  That  the  tongue,  lips  and  cheek  exert  no  influx 


22 


QUIZ  COMPEND 


ence  in  moving  the  teeth  from  their  original  direction. 
This  is  due  to  the  shape  of  the  jaw. 

Q.  What  is  Sam  Harbert’s  theory? 

A.  That  irregularities  of  the  teeth  are  due  to  pre¬ 
mature  extraction  of  the  deciduous  teeth  and  protru¬ 
sion  of  the  permanent  before  the  absorption  of  a 
deciduous  fang.  A  projection  of  the  lower  jaw  is 
attributable  to  neglect  in  second  dentition.  Generally 
it  is  supposed  to  be  due  to  elongation  of  the  jaw,  which 
is  almost  always  an  error.  When  the  dental  arch 
becomes  contracted  at  the  medial  line,  giving  to  the 
mouth  a  pointed  appearance,  it  is  often  the  result  of 
premature  extraction  of  temporary  teeth. 

Q.  What  is  Alfred  Canton’s  opinion? 

A.  That  irregularity  of  teeth  as  regards  shape, 
position,  direction,  crowded  condition,  etc.,  is  met 
with  more  frequently  than  is  supposed  to  be  the  case. 
The  causes  are  chiefly  mechanical,  depending  either  on 
the  non-increase  in  size  of  the  jaw  in  proportion  to  the 
growth  of  the  teeth  to  be  contained  in  the  alveolar 
arch;  on  the  position  of  the  permanent  teeth  with  ref¬ 
erence  to  the  fangs  of  their  predecessor,  and  lastly,  on 
the  increase  in  size  of  one  jaw  in  preference  to  the 
other. 

Q.  What  is  C.  F.  Delabarre’s  opinion? 

A.  That  malformation  of  denture  may  be  occa¬ 
sioned  by  defective  conformation  of  the  jaw;  by  simple 
arrest  of  development  dependent  upon  the  health  of 
the  individual;  by  excess  of  development  of  the  teeth, 
though  the  jaws  be  in  other  respects  well  formed;  by 
rapid  development  in  the  dentition  of  one  set,  and 
delay  in  that  of  the  other;  by  the  too  great  size  of  the 
teeth  of  one  jaw,  which  do  not  harmonize  with  those 


I 


23 


ON  IRREGULARITIES  OF  THE  TEETH. 

that  are  opposite.  Some  forms  of  defective  palatine 
arches  are  hereditary. 

O.  What  was  J.  R.  Duval’s  opinion? 

A.  That  in  a  projecting  chin,  the  alveolar  arch,  in 
which  the  incisors  and  canines  are  placed,  has  taken 
a  development  upon  a  parabolic  line — greater  and 
more  prominent  than  that  presented  by  the  bone. 
This  differs  very  little  from  a  similar  one  in  the  upper 
jaw,  which  projects  over  the  lower.  Upon  attention 
to  shedding  of  the  temporary  teeth  depends  the  fine 
arrangement  of  the  lower. 

O.  What  was  Gunnell’s  opinion  in  regard  to  pro¬ 
trusion  of  the  lower  jaw? 

A.  That  while  in  many  cases  hereditary,  it  is  often 
brought  about  in  the  following  manner:  The  incisors 
of  the  lower  jaw  are  cut  first,  and  when  the  upper 
ones  appear,  the  lower  have  nearly  arrived  at  full 
growth.  In  closing  the  mouth,  they  come  in  contact 
with  the  gum  on  the  inside  of  the  upper  incisors,  and 
for  relief  the  lower  jaw  is  thrust  out,  which  condition 
soon  becomes  permanent. 

Q.  Wrhat  was  the  opinion  of  Samuel  Cartwright,  Jr.  ? 

A.  That  irregularities  of  the  permanent  are  due, 
first,  to  non-absorption  of  the  roots  of  the  temporary 
teeth  in  proportion  to  the  rise  of  those  of  replacement. 
Second,  to  the  great  difference  which  commonly  exists 
in  the  size  of  the  new  teeth  as  compared  with  those  of 
.the  first  set.  Third,  to  contraction  of  the  arches  of 
the  jaws  and  other  malformations  of  the  maxillary 
and  palate  bones  originating  in  hereditary,  congenital, 
and  other  causes. 

Q.  What  were  the  conclusions  of  Messrs.  Mummery 


24 


QUIZ  COMPEND 


and  Nichols,  in  i860,  after  observations  upon  the  teeth 
of  primitive  races? 

A.  They  found  that  irregularities  of  the  teeth,  and 
contracted  jaws,  were  rare. 

Q.  What  did  Messrs.  Coleman  and  Cartwright’s 
observations  show? 

A.  That  the  primitive  skulls  in  Kent,  England,  had 
well  developed  jaws  and  alveolar  arches.  The  teeth 
still  present  were  remarkably  regular. 

Q.  What  opinion  did  Samuel  Cartwright  express 
in  1864? 

A.  That  irregularities  result  from  selective  breed¬ 
ing;  that  they  both  are  congenital  and  hereditary; 
that  there  is  very  little  increase  in  the  anterior  part  of 
the  jaw  after  eight  or  ten  years;  that  if  the  tem¬ 
porary  teeth  were  to  remain,  the  jaws  would  not 
change  from  those  of  childhood;  that  in  all  cases 
irregularity  of  the  maxillae  are  more  or  less  altered  in 
proportion  of  development,  whilst  the  teeth  maintain 
in  regard  to  size  an  average  development. 

O.  What  did  A.  A.  Blount  suggest? 

*V  O  CD 

A.  That  the  remote  causes  which  produce  irregu¬ 
larity  will  be  found  in  the  -commingling  of  all  nations 
with  national  and  individual  characteristics.  The 
most  frequent  causes  are  the  result  of  accident,  indis¬ 
criminate  action  of  the  deciduous  teeth,  and  too  early 
extraction  of  the  permanent  teeth. 

O.  What  did  H.  Sewell  suggest? 

A.  That  protrusion  of  the  incisors  is  apparently 
due  to  an  abnormal  development  of  the  maxillary 
bone.  Irregularities  are  due  to  retention  of  temporary 
teeth,  causing  permanent  tee  .h  to  assume  an  un¬ 
natural  position ;  also  to  malformation  of  the  jaw, 


ON  IRREGULARITIES  OF  THE  TEETH. 


25 


which  is  'usually  congenital  and  at  the  same  time 
hereditary.  They  may  be  due,  however,  to  injury  and 
to  accidental  causes. 

Q.  What  did  J.  L.  Down  find? 

A.  That  excessive  vaulting  of  palate  is  due  to 
arrest  of  development  of  the  sphenoid  or  defective 
growth  of  the  vomer.  The  defects  are  development 
defects,  and  betoken  a  cause  long  anterior  to  the  time 
when  sucking  the  thumb  is  practiced, unless  that  habit 
be  an  intra-uterine  one. 

Q.  To  what  does  Kingsley  attribute  irregularities? 

A.  Irregularities  are  attributed  chiefly  to  prema¬ 
ture  extraction  of  temporary  teeth,  marriage  between 
persons  of  different  nationalities,  heredity,  or  dis¬ 
turbed  innervation. 

Q.  What  is  S.  H.  Guilford’s  division? 

A.  Hereditary  and  acquired. 

Q.  What  did  the  author  conclude  in  1880? 

A.  That  the  shape  and  size  of  the  jaws  may  be 
inherited,  but  the  manner  of  the  eruption  of  the  teeth 
is  not  transmitted,  hence  irregularities  of  the  dental 
arch  per  se  are  not  inherited. 

Q.  What  other  point  did  he  settle? 

A.  That  the  muscles  of  the  mouth  and  cheeks  have 
nothing  to  do  with  the  production  of  the  V-shaped  or 
saddle  arch  or  their  modifications. 

Q,  What  was  shown? 

A.  That  the  only  tissues  involved  in  the  production 
of  irregularities  are  the  teeth  on  the  one  hand  and  the 
jaw  bone  and  alveolar  process  on  the  other;  that  the 
incisors  in  the  V-shaped  arch  always  protrude,  and 
never  in  the  saddle ;  that  the  manner  of  the  forma¬ 
tion  of  irregularity  is  in  the  arrangement  of  the  teett\ 


26 


QUIZ  COMPEND 


(no  matter  what  position  the  teeth  take,  the  alveolar 
process  builds  itself  about  them  to  hold  them  in  posi¬ 
tion)  ;  that  there  is  a  decided  difference  between  the 
deformities  produced  by  thumb-sucking  in  its  various 
forms  and  the  V  and  saddle  arches.  Owing  to  the  jaws 
being  transitory  structures  with  an  unstable  nervous 
system,  excessive  and  arrest  of  development  takes 
place.  One  jaw  may  be  excessive,  the  other  arrested. 

O.  What  are  some  of  the  causes  of  an  unstabl 
nervous  system? 

A.  Debilitating,  acute  diseases  of  children  are 
noticeably  often  followed  by  sudden  overgrowth  or 
undergrowth  of  bone.  Cases  of  pneumonia  and 
measles  are  followed  by  dental  and  maxillary  deform¬ 
ities.  Inherited  or  acquired  neuropathic  states  are  also 
evinced  at  the  periods  of  stress  marked  by  dental 
evolution  or  involution.  Irregularities  are  due  to  con¬ 
stitutional  origin,  developing  with  the  osseous  system, 
and  to  local  origin.  Irregularities  cannot  occur  until 
the  teeth  have  erupted  (as  nothing  can  exist  except  it 
be  present).  This  shows  their  relation  to  each  other 
and  to  the  jaw.  Deformities  always  commence  at  the 
sixth  year,  and  are  completed  by  the  twelfth.  The 
forward  movement  of  the  posterior  teeth  produce  the 
same  results  as  arrest  of  development  of  the  maxilla. 
The  vault  is  not  contracted  by  mouth  breathing.  Con¬ 
tracted  arches  are  as  common  among  low  vaults  as 
high,  but  appear  high  because  of  the  contraction. 
Mouth  breathing  (due  to  hypertrophy  of  the  nasal 
bones  and  mucous  membranes,  deformities  of  the  nasal 
bones,  adenoids,  or  any  pathologic  condition  producing 
stenosis)  does  not  cause  contracted  jaws,  but  like  t1  •'.se 
is  due  to  neuroses  of  development. 

Q.  What  is  Colyer’s  summary? 


ON  IRREGULARITIES  OF  THE  TEETH.  27' 

A.  The  opinion  of  previous  writers  into  the  state¬ 
ment  that  the  causes  which  produce  irregularities  of 
the  teeth  are  general  and  local. 

Q.  In  1901,  to  what  did  Arbuthnot  Lane  call  atten¬ 
tion? 

A.  To  the  association  of  deformities  of  the  alveolar 
process  and  constitutional  deficiencies  (like  those  of 
the  chest)  referring  the  deformities  to  the  action  of 
local  factors  and  ignoring  the  underlying  constitu¬ 
tional  element. 

Q.  Give  a  summary  of  the  theories  in  the  order  in 
which  they  have  been  advanced  to  1880. 

A.  Irregularities  of  the  teeth  were  early  recog¬ 
nized  and  attempts  made  toward  correction.  Irregu¬ 
larities  were  charged:  To  too  long  retention  of  the 
temporary  teeth,  too  early  removal  of  the  temporary 
teeth,  to  supernumerary  teeth,  narrow  jaws,  inverted 
teeth,  thumb-sucking,  mouth-breathing,  enlarged 
tonsils,  want  of  development  of  the  jaw  bones,  intem¬ 
perance,  heat  and  cold,  sucking  the  tongue,  extracting 
teeth  on  the  upper  jaw  and  neglect  to  extract  the 
same  number  on  the  lower,  the  influence  of  the 
tongue,  lips,  and  cheeks,  the  form  of  the  palate,  tongue 
hypertrophy,  heredity,  too  great  permanent  teeth  for 
the  space,  pressure  of  the  temporary  against  the  per¬ 
manent,  want  of  interstitial  growth,  from  removal  of 
the  temporary  teeth  (the  bone  scar  prevents  the  per¬ 
manent  teeth  from  erupting  regularly)  sleeping  with 
the  mouth  open,  cross  breeding,  constitutional  factors, 
congenital  states,  early  decay  and  loss  of  the  tempo¬ 
rary  teeth,  non-absorption  of  the  roots  of  the  tem¬ 
porary  teeth,  selective  breeding,  arrest  of  development 
of  the  sphenoid  or  defective  growth  of  the  vomer, 
artificial  life,  disturbed  innervatiou. 


-  ' 


CHAPTER  II. 


HEREDITY. 

Q.  What  are  Luys’  views  as  to  heredity? 

A.  That  the  individual  that  comes  into  the  world 
is  but  one  link  in  a  long  chain  which  is  unrolled  by 
time,  and  the  first  links  of  which  are  lost  in  the  dim 
past. 

Q.  What  are  the  antecedents  of  the  individual? 

A.  He  has  not  merely  two  parents  but  the  ancestors 
behind  him. 

Q.  Do  these  ancestors  represent  the  same,  or  differ¬ 
ent  types? 

A.  These  two  parents  may  represent  ancestors  of 
very  different  types,  whose  qualities,  seemingly  absent 
in  the  parent,  will  appear  in  the  descendant. 

Q.  Do  the  relative  functions  of  the  sexes  become 
a  factor? 

A.  They  are  a  potent  factor  to  be  taken  into  consid¬ 
eration  in  estimating  its  influence. 

Q.  What  part  does  the  female  play? 

A.  The  original  function  of  reproduction,  that  of 
cell  division,  is  the  part  of  the  female. 

Q.  What  part  does  the  male  play? 

A.  The  male  in  the  lower  types  of  life  (some  plants 
and  infusoriae)  simply  supplies  the  female  with  nour¬ 
ishment. 

Q.  What  happens  with  rise  in  evolution? 

A.  The  protoplasm  is  differentiated. 

Q.  Which  furnishes  the  type? 

29 


30 


QUIZ  COMPEND 


A.  The  female,  which  is  the  best  capable  of  devel¬ 
opment,  and  which  is  properly  nourished  by  a  highly 
developed  male. 

Q.  Which  produces  the  greatest  influence  in  the 
offspring? 

A.  As  the  product  of  fructification  is  longest  under 
the  nutritive  influence  of  the  female,  her  influence  is 
most  potent  in  redeeming  defects  or  producing  them. 

Q.  Are  results  identical  from  parent  to  child? 

A.  It  is  an  incorrect  conception  of  the  law  of 
heredity  that  looks  for  identical  phenomena  in  each 
succeeding  generation. 

Q.  What  views  have  been  expressed  if  the  mental 
characteristics  of  the  child  be  not  similar  to  the 
parent? 

A.  Some  have  refused  to  admit  that  mental  facul¬ 
ties  were  subject  to  heredity,  because  the  mental  char¬ 
acteristics  of  the  descendants  were  not  precisely  those 
of  the  progenitors. 

Q.  On  what  grounds? 

A.  That  each  generation  must  copy  the  preced¬ 
ing.  Father  and  son  must  present  the  spectacle  of 
one  being  having  two  births  and  each  time  leading  the 
same  life  under  the  same  conditions. 

Q.  Where  must  the  application  of  the  law  of  hered¬ 
ity  be  sought? 

A.  It  is  not  in  the  heredity  of  function  or  of  organic 
or  intellectual  facts  that  the  application  of  the  law  of 
heredity  must  be  sought,  but  at  the  very  fountain 
head  of  the  organism  in  its  inmost  constitution. 

Q.  How  is  heredity  divided? 

A.  Direct,  indirect  and  telegony. 

Q.  What  is  direct  heredity? 


ON  IRREGULARITIES  OF  THE  TEETH.  31 

A.  Direct  heredity  consists  in  the  transmission  of 
paternal  and  maternal  qualities  to  the  children? 

Q.  How  is  this  divided? 

A.  This  form  has  two  aspects.  The  child  takes 
after  the  father  and  mother,  equally  as  regards  both 
physical  and  moral  characters, a  case, strictly  speaking, 
of  very  rare  occurrence;  (2)  or  a  child,  while  taking 
after  both  parents,  more  especially  resembles  one  of 
them. 

Q:  What  distinction  must  again  be  made  between 
two  cases? 

A.  The  first  of  these  occurs  when  the  heredity  takes 
place  in  the  same  sex  from  father  to  son  or  from 
mother  to  daughter. 

Q.  What  is  the  other  form? 

A.  The  other,  which  is  more  frequent,  appears 
when  heredity  occurs  between  different  sexes,  from 
father  to  daughter,  or  from  mother  to  son. 

Q.  What  is  reversed  heredity,  or  atavism? 

A.  It  consists  in  the  reproduction,  in  the  descend¬ 
ants,  of  the  moral  or  physical  qualities  of  their  ances¬ 
tors. 

O.  How  does  this  occur? 

A.  It  frequently  occurs  between  grandfather  and 
grandson,  as  well  as  between  grandmother  and  grand¬ 
daughter. 

Q.  What  is  collateral  or  indirect  heredity? 

A.  It  is  of  rarer  occurrence  than  the  foregoing,  and 
is  simply  a  form  of  atavism,  which  subsists  as  indi¬ 
cated  by  name  between  individuals  and  their  ancestors 
in  the  direct  line — uncle  or  granduncle  and  nephew, 
aunt  or  niece.  • 

Q.  What  is  tclegony,  or  the  heredity  of  influence? 


3 


QUIZ  COMPEND 


A.  It  consists  in  reproduction  in  the  children  by  a 
second  marriage  of  some  peculiarity  belonging  to  a 
former  spouse. 

Q.  Do  morbid  parents  always  have  morbid 
children? 

A.  The  descendants  of  a  victim  of  morbidity  or 
abnormality  do  not  always  exhibit  the  morbidity  or 
abnormality  of  the  parent. 

O.  Is  morbid  heredity  ever  wanting? 

A.  It  is  most  often  not  present  to  the  full  extent. 

Q.  Is  it  not  sometimes  slight  in  the  child? 

A.  Frequently  slighter  abnormalities  than  those  in 
the  parent  may  be  detected. 

Q.  What  two  independent  principles  are  here 
evident? 

A.  The  transmutation  of  heredity  and  the  atavism 
upon  which  it  depends.  Atavism  at  times  tends  to 
preserve  the  type  and  offsets  the  influence  of  degen¬ 
eracy. 

Q.  What  does  it  underlie? 

A.  Not  merely  the  production  of  the  sound  action 
of  degenerate  stock,  but  also  those  in  whom  the 
degeneiacy  affects  the  earlier,  and  not  the  later,  ac¬ 
quirements  of  the  race. 

Q.  What  direction  does  manifestation  of  morbid 
heredity  take? 

A.  The  line  of  least  resistance. 

Q.  What  is  the  extent  and  direction  of  the  line  of 
least  resistance? 

A.  It  depends  upon  the  amount  of  healthy  atavism 
which  separate  organs  and  structures  of  the  body  pre¬ 
serve. 

Q.  Is  this  also  true  of  the  cells  forming  its  organs? 


ON  IRREGULARITIES  OF  THE  TEETH. 


33 


A.  What  is  true  of  the  organism  as  a  whole  is  also 
true  of  the  cells  forming  its  organ. 

Q.  Is  there  a  struggle  for  existence  on  the  part  of 
the  cells? 

A..  While  cell  life  is  altruistic  or  subordinate  to  the 
life  of  the  organ  and  through  it  to  the  life  of  the  organ¬ 
ism  as  a  whole,  still  this  altruism  is  not  so  complete 
as  to  prevent  entirely  a  struggle  for  existence  on  the 
part  of  the  cells  or  individual  organs. 

O.  Does  this  struggle  increase,  or  decrease? 

A.  With  advance  in  evolution  this  struggle  de¬ 
creases,  to  increase  with  the  opposite  procedure  of 
degeneracy. 

Q.  What  is  the  result? 

A.  From  it  results  the  phenomena  of  arrest  and 
excessive  development. 

Q.  By  whom  was  this  struggle  for  existence  pointed 
•out? 

A.  It  was  first  pointed  out  by  Aristotle,  who 
showed  that  one  organ  was  often  sacrificed  for  the 
development  of  another. 

Q.  Was  this  more  clea-rly  pointed  out  later? 

A.  It  was,  and  freed  from  obscurity  by  Goethe  in 
1807,  and  St.  Hilaire  in  1816. 

Q.  What  is  this  law  called? 

A.  The  law  under  which  the  struggle  operated  is 
known  as  the  law  of  economy  of  growth. 

Q.  How  does  it  operate? 

A.  Its  action  sometimes  aids,  sometimes  repels 
and  prevents  degeneracy. 

•Q  What  did  VonBaer  point  out? 

A.  That  the  vertebrate  embryo  of  the  higher  type 
has  in  it  all  the  potentialities  of  the  organs  and  struc- 


34 


QUIZ  COMPEND 


tures  found  in  lower  types,  therefore,  in  proportion 
as  the  ancestry  is  strengthened  do  these  potentialities 
remain  latent. 

Q.  What  is  the  reverse? 

A.  In  proportion  as  the  ancestry  becomes  a  subject 
of  nervous  exhaustion  these  potentialities  gain  nutri¬ 
tion  at  the  expense  of  the  later  acquired  organs,  which 
are  the  ones  likely  to  be  affected  by  nervous  exhaustion. 

Q.  Have  all  the  organs  of  the  body  their  own 
nervous  system? 

A.  Practically  they  have,  and  it  exercises  a  control 
over  their  nutrition  through  its  influence  on  the  blood 
supply  and  the  means  of  excretion. 

Q.  How  are  these  local  actions  regulated? 

A.  By  the  control  of  the  nervous  system  for  the 
benefit  of  the  organism  as  a  whole. 

Q.  What  results  when  the  central  nervous  system 
becomes  involved? 

A.  When  the  central  nervous  system  becomes 
weakened,  the  local  nervous  system  given  free  play 
first  draws  greater  nourishment  and  increased  power 
and  thereby  becomes  itself  exhausted  and  a  struggle 
for  existence  occurs  between  its  parts. 

Q.  What  results? 

A.  As  in  the  case  of  tumors  and  cancers,  cells  take 
on  the  power  of  reproduction,  which  for  a  long  time 
they  had  lost  for  the  benefit  of  the  organism  as  a 
whole. 

Q.  What  effect  has  this  struggle  for  existence? 

A.  It  produces  effects  which  are  handed  down  by 
heredity  or  are  fought  by  atavism. 

Q.  Are  these  factors  a  benefit,  as  well  as  a  detri¬ 
ment? 


ON  IRREGULARITIES  OF  THE  TEETH. 


35 


A.  It  is  obvious,  therefore,  that  these  two  factors 
in  heredity  may  play  beneficial  as  well  as  injurious 
parts  on  the  offspring. 

Q.  What  effect  does  atavism  have  upon  deformities? 

A.  As  a  rule  atavism  plays  a  beneficial  part  in 
correcting  degenerate  tendencies. 

Q.  To  what  extent  may  this  be  carried? 

A.  It  may  either  be  complete  in  the  shape  of  a  per¬ 
fect  return  to  a  normal  ancestor  or  may  be  so  incom¬ 
plete  as  to  moderate  in  the  offspring  the  extended 
nervous  exhaustion  which  his  ancestor  has  trans¬ 
mitted. 

Q.  What  are  the  biologic  effects  of  degenerative 
forces  on  heredity  as  shown  by  Moreau  (de  Tours)  ? 

A.  First,  absence  of  conception;  second, 
retardation  of  conception;  third,  imperfect  conception ; 
fourth,  incomplete  products  (monstrosities) ;  fifth, 
products  whose  mental,  moral  and  physical  constitu¬ 
tion  is  imperfect;  sixth,  products  specially  exposed  to 
nervous  disorders  in  order  of  frequency,  as  follows: 
Epilepsy,  imbecility,  idiocy,  deaf-mutism,  insanity 
and  other  cerebral  disorders;  seventh,  lymphatic  pro¬ 
ducts  predisposed  to  tuberculosis  and  allied  disorders; 
eighth,  products  which  die  in  infancy  in  a  greater  pro¬ 
portion  than  sound  infants  under  the  same  conditions; 
ninth,  products  which,  although  they  escape  the  stress 
of  infancy,  are  less  adapted  than  others  to  resist  dis¬ 
ease  and  death. 

Q.  Are  there  more  stillborn  children? 

A.  There  are  more  deadborn  children  in  plural 
pregnancies  and  children  born  alive  are  more  difficult 
to  rear. 

O.  What  are  Ansell’s  views  as  to  this  matter? 


'36 


QUIZ  COMPEND 


A.  The  proportion  of  infants  stillborn  or  dying  soon 
after  birth  is,  in  the  case  of  males,  nearly  five  times, 
and  in  the  case  of  females,  nearly  four  times,  greater 
in  multiple  than  in  single  births. 

Q.  What  did  J.  M.  Duncan  find? 

A.  Pluriparity  is  especially  associated  with  idiocy 
and  imbecility  and  it  especially  affects  the  sterile  ages 
or  the  ages  of  weakness  of  reproduction. 

Q.  What  did  Arthur  Mitchell  show? 

.  A.  That  among  imbeciles  and  idiots  a  much  larger 
proportion  is  found  to  be  twin-born  than  among  the 
general  community. 

O.  What  was  observed  among  relatives  of  imbe¬ 
ciles  and  idiots? 

A.  That  twinning  is  very  frequent. 

Q.  When  twinning  is  frequent,  are  deformities 
common? 

A.  Bodily  defects  likewise  occur  frequently. 

Q.  What  effect  does  twinning  have  upon  the  econ¬ 
omy? 

A.  It  indicates  imperfect  development  and  feeble 
organization  of  the  product. 

Q.  What  did  Herbert  Spencer  show? 

A.  That  with  increase  in  growth  and  specialization 
must  occur  decrease  in  the  explosive  manifestations 
of  life. 

Q.  What  effect  has  this  on  reproduction? 

A.  Among  these  explosive  manifestations  in  early 
biologic  history  is  the  function  of  reproduction,  which 
is  common  to  all  cells. 

Q.  What  occurs  with  advance  of  evolution? 

A.  The  functions  of  cells  become  specialized  and 
the  extent  of  reproductive  power  decreased. 


ON  IRREGULARITIES  OF  THE  TEETH. 


37 


Q.  What  did  Spencer  call  this  specialization? 

A.  He  designates  it  individuation. 

Q.  What  effect  does  degeneracy  produce? 

A.  The  organism  returns  to  the  lower  type  and 
consequently  tends  to  reversion  of  individuation.  = 

Q.'  What  results? 

*  A.  First  occurs  absence  of  conception  to  which 
Moreau  de  Tours  refers. 

Q.  'What  happens  if  the  organism  be  less  affected? 

A.:  The  plural  and  frequent  repeated  births  of 
degeneration  occur.  r . 

'  :  Q.  Are  abortions  more  frequent  in  plural  births? 

A.  They  are  comparatively  more  frequent  than  in 
ordinary  pregnancies. 

O.  Are  monstrosities  common? 

:  A;  Monstrosities  of  all  kinds  are  more  common  in 
plural  than  in  ordinary  pregnancies. 

Q.  How  is  it  shown  that  twinning,  triplets,  etc., 
are  a  departure  from  the  physiologic  rule? 

A.  Everything  known  concerning  triplets  and 
quadruplets  supports  the  opinion  derived  from  twins. 

.  Q.  What  observations  support  these  views? 

A.  Valenta’s,  who  observed  two  epileptics  (mother 
and  ’  daughter)-  who  illustrated  this  very  decidedly. 
The  mother  had  thirty-eight  children,  six  times  twins, 
four  times  triplets,  and  twice  quadruplets.  The 
daughter,  at  the  age  of  forty,  had  thirty-two  children, 
three  times  twins,  six  times  triplets  and  twice  quad¬ 
ruplets,  and  Kiernan,  who  found  that  ninety  families 
of  degenerates  averaged  eleven  children  each.  Trip¬ 
lets,  quadruplets  and  twins  were  more  than  ten  times  as 
frequent  as  among  the  population  taken  as  a  whole. 

O.  What  inference  results  from  this? 


38 


QUIZ  COMPEND 


A.  That  occurrence  of  large  families  should  bfe 
regarded,  not  as  an  expression  of  advance, but  of  degen¬ 
eracy. 

Q.  How  is  the  status  in  evolution  determined  by 
progeny? 

A.  When  multiple  and  frequent  progeny  occur  in 
a  family,  the  condition  must  be  regarded  as  a  trans¬ 
formation  of  malign  heredity. 

Q.  What  results  from  these  conflicting  factbrs? 

A.  That  direct  heredity  is  rare,  and  that  acquired 
influences  are  apt  to  expend  their  force  upon  unstable 
structures,  most  subject  to  the  struggle  for  existence 
occurring  within  the  organism. 

Q.  Are  the  skull,  jaws  and  teeth  liable  to  this  pre¬ 
disposition? 

A.  Their  instability  predisposes  them  to  the  strug¬ 
gle,  and  hence  renders  them  peculiarly  liable  to  the 
ply  of  hereditary  influences  or  acquired  defects  of  an 
ancestor. 

Q.  How  does  heredity  act? 

A.  It  merely  furnishes,  in  case  of  the  jaws  and 
teeth,  powder  to  be  lighted  up  by  factors  locally  apfplied 
during  periods  of  stress  after  birth. 

Q.  Without  these  locally  applied  excitants,  what 
would  result? 

A.  The  types  usually  ascribed  to  heredity  by 
dentists  will  not  occur. 

Q.  What  furnishes  the  match? 

A.  Environment  furnishes  the  match,  but  it  makes 
a  great  difference  whether,  as  Havelock  Ellis  says,  the 
match  be  thrown  into  a  powder  magazine  or  the  sea. 

O.  What  is  Weismann’s  position? 

A.  He  denies  the  inheritance  of  acquired  defects. 


ON  IRREGULARITIES  OF  THE  TEETH, 


39 


Q.  Has  he  modified  his  opinion  since  making  the 
statement? 

A.  An  attempt  to  transfer  his  position  from  the 
domain  of  biology  to  that  of  pathology  led  him  to 
encounter  facts  he  was  obliged  to  explain  in  a  manner 
inconsistent  with  his  original  position. 

Q.  What  are  his  latest  views? 

A.  He  admits  the  origin  of  a  variation  equally 
independent  of  selection,  and  amphimixis  is  due  to 
constant  occurrence  of  slight  inequalities  of  nutrition 
of  the  germ  plasm. 

Q.  Do  these  variations  accumulate? 

A.  These  variations  are  at  first  infinitesimal,  but 
may  accumulate,  and  in  fact  they  must  do  sb  when 
the  modified  conditions  of  nutrition  which  give  rise 
to  them  have  lasted  for  several  generations. 

Q.  Upon  what,  according  to  Weismann,  does  indi¬ 
vidual  variability  depend? 

A.  Individual  variability,  according  to  Weismann, 
cannot  be  charged  to  direct  action  of  external  influ¬ 
ence  upon  the  germ  ceils  and  their  contained  germ 
plasm,  since  these  are  very  difficult  to  change,  yet  he 
admits  that  this  structure  may  possibly  be  altered  by 
influences  of  the  same  kind  continuing  fof  a  very  long 
time. 

Q.  Why  does  Weismann  claim  that  the  causes  of 
inheritable  differences  must  be  sought  elsewhere  than 
in  these  varying  influences? 

A.  Influences  which  are  mostly  of  variable  nature, 
tending  now  ih  ono  direction,  now  in  another,  as  they 
do  not  act  continuously,  can  hardly  produce  a  change 
in  the  structure  of  the  germ  plasm. 

O.  What  does  Weismann  admit  as  to  birth  marks? 


40 


QUIZ  COMPEND 


A.  That  there  are  a  number  of  congenital  deform¬ 
ities,  birthmarks  and  other  individual  peculiarities, 
which  are  inherited. 

Q.  Are  these,  according  to  Weismann,  acquired 
characters?  \  - 

A.  Yes. 

O.  What  was  their  origin? 

A; -They  must  have  once  appeared  for  the  first 
time.  ' 

'■  Q.  What,  according  to  Weismann,  caused  them? 

A.  At  least  a  great  proportion  of  them  proceed 
from  the  germ  itself,  and  must,  therefore,  be  due  to 
alteration  of  the  germinal 'substance.  ■ 

"  Q.  How,  according  to  Weismann,  must  the  inher¬ 
itance  of  acquired  characters  be  proven? 

A.  If  any  of  these  hereditary  deformities  originate 
in  the  action  of  some  external  cause  upon  the  already 
formed  body  (soma)  of  the  individual  and  not  upon  the 
germ  cell,  then  the  inheritance  of  acquired  characters 
is  proven. 

O.  How  does  Weismann  show  that  such  heredity 
of  acquired  characters  occurs? 

•  -  A.  By  admitting  that  tuberculosis  may  produce 
what  he  calls  a  “habit”  “in  the  ancestor,  which  may 
be  transmitted  to  the  descendants.  This  habit  con¬ 
sists  in  the  formation  of  structural  peculiarities,  such 
as  narrowness  of  the -chest,  etc.”  The  admission  of 
such  a  “habit”  offsets  any  denial  of  the  inheritance  of 
acquired  characters.  : 

O.  ;Have  recent  investigations  sustained  the  dis¬ 
tinction  between  the  germ  and  body  plasm? 

A.  They  have  destroyed  the  embryologic  distinc¬ 
tion  -between  the  germ  plasm  and  the  body  plasm  and 


ON  IRREGULARITIES  OF  THE  TEETH. 


41 


disproved  the  claim  that  the  first  division  of  the  cell 
represented  separation  of  body  plasm  and  germ  plasm. 

O.  How  often  may  these  cells  be  divided  before 
they  can  pursue  a  separate  existence? 

A.  They  may  be  divided  twice,  four  times,  and 
even  sixteen  times,  if  disassociated  for  growth,  before 
separate  cells  can  become  well  developed  organisms  of 
the  parent  type. 

Q.  What  do  experiments  in  production  of  double 
monstrosities  show? 

A.  They  long  ago  cast  suspicion  upon  the  embryo- 
logic  position  of  Weismann. 

Q.  Of  what  value  have  been  his  researches? 

A.  They  have  done  undeniable  good  in  destroying 
loose  notions  as  to  direct  heredity  previously  present. 


CHAPTER  III. 


CONGENITAL  FACTORS  AND  MATERNAL  IMPRES¬ 
SIONS. 

Q.  Can  all  abnormal  conditions  associated  with  the 
child  at  birth  be  considered  inherited? 

A.  Hereditary  influences  must  be  separated  from 
factors  occurring  during  one  pregnancy  which  affect 
the  product  of  that  pregnancy  alone. 

Q.  What  are  these  factors? 

A.  These  are  the  factors  causing  “maternal  impres¬ 
sions,”  or  so-called  mother’s  marks  and  other  defects. 

Q.  What  are  maternal  impressions? 

A.  Maternal  impressions  have  been  excellently 
illustrated  by  a  case  reported  nearly  two  decades  ago 
by  T.  C.  Poole,  of  Mansfield,  Texas.  His  sow  gave 
birth  (April,  1883,)  to  eight  fully  developed  pigs.  The 
ninth  had  the  appearance  of  an  elephant.  It  was 
destitute  of  hair,  had  dependent  ears,  a  proboscis,  two 
eyes  behind  upper  two-thirds  of  proboscis,  closely 
approximated,  yet  distinct,  an  abnormal  superior 
maxillary,  containing  three  large  teeth  with  a  long, 
thin  upper  lip  of  elephantine  shape  and  color.  The 
sow’s  gestation  lasts  three  months  and  twenty  days. 
On  Christmas  day,  1882,  the  boar  was  with  her. 
December  29th,  a  menagerie  had  an  elephant  staked 
about  three  hundred  yards  from  where  the  sow  was, 
and  in  full  view. 

O.  What  were  the  causes  of  this  “maternal  impres- 
sion-' 


43 


44 


QUIZ  COMPEND 


A.  The  pig  descending  from  the  proboscidea,  has, 
at  one  stage  in  intra-uterine  development,  a  proboscis, 
whose  musculature  is  still  retained  by  the  adult  pig,  in 
whom  the  nose  plays,  to  some  extent,  the  part  of  a 
hand  for  rooting  purposes.  The  cause  was,  therefore, 
arrested  development  at  the  period  of  pig  intra-uterine 
development  when  the  proboscis  existed.  This  arrested 
development  could  have  arisen  from  nervous  shock  to 
the  sow  alleged,  since  these  animals  are  easily  upset 
during  gestation. 

Q.  What  are  the  usual  views  of  maternal  impres¬ 
sion  causes? 

A.  Maternal  impressions  have  been  considered 
from  one  standpoint  only,  and  that  is  as  to  their  sup¬ 
posed  cause  and  its  method  of  action.  As  the  supposed 
cause  is  psychic  and— in  the  conception  of  it  usually 
adopted — immaterial  in  action,  an  absurd  credulity 
respecting  its  powers,  which  existed  at  one  time  amone 
obstetricians,  has  given  way  to  an  equally  absurd  skep¬ 
ticism. 

Q.  Do  maternal  impressions  occur  from  mental 
photograph? 

A.  Specimens  exist  of  newly-hatched  chicks  with 
a  curved  beak,  like  a  parrot,  and  the  toes  set  back,  as 
in  that  bird.  The  hens  in  the  yard,  where  these  mon¬ 
strosities  were  hatched,  had  been  frightened  by  a 
female  parrot,  which,  having  escaped,  fluttered  among 
them  before  the  eggs  were  laid,  and  greatly  frightened 
the  hens  from  whose  eggs  the  malform  chicks  were 
hatched.  This  seems  to  confirm  the  photographic 
theory  of  maternal  impressions;  but  these  malforma¬ 
tions  are  simply  arrests  of  development,  since  birds  are 
aberrant  reptiles  belonging  to  the  sauropsidae,  and 


ON  IRREGULARITIES  OF  THE  TEETH. 


45 


during  their  embryonic  development  pass  through  the 
reptilian  phase. 

Q.  In  a  general  way,  how  may  alleged  mental  im¬ 
pressions  be  divided? 

A.  Into  two  classes.  First,  those  in  which  an 
arrest  of  embryonic  development  has  occurred,  which 
may  or  may  not  be  traceable  to  the  alleged  impression. 
Second,  photographic  impressions  charged  to  a  factor 
utterly  incapable  of  producing  them,  because  of  the 
late  period  in  embryonic  life  at  which  the  impres¬ 
sion  is  alleged  to  have  acted. 

Q.  How  do  mental  shocks  act  on  the  organization? 

A.  In  a  purely  physical  manner.  Since  all  that  is 
known  of  the  mind  is  known  of  it  as  related  to  the 
purely  physical  conditions  through  which  it  acts, 
whether  its  action  be  initiated  by  conditions  affecting 
physically  the  various  sense  organs  or  not. 

Q.  Does  the  foetus  react  to  mental  influence  on  the 
mother? 

A.  It  often  exhibits  very  decided  reaction  to  sen¬ 
sory  impressions  on  the  mother,  whose  dreams  affect 
the  foetus.  Even  ordinary  dreams  of  moderate  excit¬ 
ation,  not  interrupting  sleep,  may  produce  foetal 
movements.  These  dreams  need  not  take  the  night¬ 
mare  type,  though  such  dreams  would  cause  sudden 
contraction,  under  the  influence  of  a  terrifying  idea, 
with  the  resultant  cardiac  disorder. 

Q.  What  effect  may  these  maternal  mental  changes 
have  upon  the  foetus? 

A.  Mental  changes  of  the  mother  excite  motor 
reaction  in  the  foetus,  and,  as  with  sensorial  excitation, 
these  reactions  are  stronger  in  the  foetus  than  in  the 

mother. 

4 


46 


QUIZ  COMPEND 


Q.  How  do  these  motor  reactions  act? 

A.  The  mechanism  of  these  motor  reactions  is 
obviously  the  unconscious  and  involuntary  movement 
of  the  uterine  walls. 

Q.  Can  the  statistic  method  of  proof  be  applied  to 
maternal  impressions? 

A.  Yes.  Of  92  children  born  in,  Paris  during  the 
siege,  64  had  slight  mental  or  physical  anomalies,  the 
remaining  27  were  all  weakly,  21  were  imbecile  or 
idiotic,  and  8  were  normally  insane. 

Q.  What  were  they  called? 

A.  These  figures  led  the  working  class  of  Paris  to 
call  children  born  in  1871  “doomed,  children.” 

Q,  What  effect  had  the  financial  crisis  of  1875-1880, 
in  Berlin? 

A.  It  was  followed  by  an  increase  in  the  number 

,  1 

of  idiots  born. 

Q.  What  effect  has  profound  mental  shock? 

A.  It  can  alter  nutrition  so  that  the  mother  shall 
furnish  poisonous  products  in  lieu  of  nutrition. 

O.  How  will  these  affect  the  foetus? 

A.  Such  poisonous  products  would  tend  to  check 
foetal  development.  ; 

Q.  While  science  rejects  the  photographic  phases 
of  maternal  impressions,  what  does  it  admit? 

A.  It  admits  that  a  class  of  causes  of  arrested  devel¬ 
opment  exists,  due  to  the  effects  of  mental  shock  upon 
the  mother. 

Q.  What  structures  are  most  liable  to  be  affected 
by  shock? 

A.  Structures  variable  in  evolution. 

Q.  What  may  they  be? 

A.  This  influence  most  strongly  affects  nutrition  of 


ON  IRREGULARITIES  OF  THE  TEETH. 


47 


the  dermal  bone  elements  of  the  skull  and  jaws,  and 
hence  must  affect  the  teeth. 

O.  When  will  the  results  be  manifested? 

A-.  The  results  of  this  will  not  always  be  obvious 
until  the  periods  of  stress. 

Q.  What  is  one  dental  result  of  foetal  arrested 
development? 

A.  One  expression  of  foetal  senescence  is  the  child 
born  with  teeth. 

Q.  When  does  this  occur? 

A.  This  occurs  under  the  law  of  economy  of  growth 
in  connection  with  arrest  of  development  at  the  sen¬ 
ile  period  of  foetal  development,  four  and  one-half 
months. 

Q.  What  grave  deformity  is  frequently  found  with 
premature  eruption  of  the  teeth? 

A.  Cyclopia  and  grave  brain  degeneracy. 

Q.  Was  the  connection  between  degeneracy  and 
teeth  at  birth  very  early  observed? 

A.  It  was  since  Shakespeare  makes  Richard  III. 
remark: 

“  The  midwife  wonder’d  and  the  woman  cried, 

O  Jesu,  bless  us,  he  is  born  with  teeth. 

And  so  I  was;  which  plainly  signified 

That  I  should  snarl  and  bite  and  play  the  dog.” 

Q.  Are  ante-natal  teeth  rare? 

A.  They  are  not.  The  significance  of  natal  erup¬ 
tion  of  teeth  is  not  that  of  vigor;  many  of  the  subjects 
succumb  early  in  life. 

Q.  Name  authorities  who  cite  instances  where 
children  have  been  born  with  teeth. 

A.  Pliny,  Columbus,  Van  Swieten,  Haller,  Marcel- 


48 


QUIZ  COMPEND 


lus,  Dinatus,  Baudeloque,  Cazeaux,  Soemmering,  and 
Gardien. 

Q.  How  many  cases  did  Haller  collect? 

A.  Nineteen  cases. 

Q.  What  prominent  men  were  born  with  teeth? 

A.  Louis  XIV.  had  two  teeth  at  birth,  Bigot,  a 
medical  philosopher  of  the  sixteenth  century,  Boyd, 
the  poet,  Valerian,  and  some  ancient  Greeks  and 
Romans. 

Q.  What  other  cases  are  on  record? 

A.  Polyderus  Virgilus  describes  an  infant  who  was 
born  with  six  teeth.  There  were  two  cases  typical  of 
foetal  dentition  shown  before  the  Academie  de  Mede- 
cine  de  Paris.  One  of  the  subjects  had  two  central 
incisors  of  the  lower  jaw,  and  the  other  had  one  tooth 
well  through.  Levison  saw  a  female  born  with  two 
central  incisors  in  the  lower  jaw. 


-  I 


r 


*! 


CHAPTER  IV. 


POST-NATAL  SKULL  AND  JAW  DEVELOPMENT  AND 

PERIODS  OF  STRESS. 

Q.  Is  the  child  an  immature  adult? 

A.  No.  The  child,  with  its  relatively  enormous 
head,  its  large,  protuberant  abdomen,  its  small  chest, 
short, feeble  legs,  comparatively  vigorous  arms,  smooth, 
almost  hairless  skin,  large  liver,  kidneys,  thymus,  and 
super-renal  capsules,  presents  a  distinct  anatomic  pic¬ 
ture  from  the  adult.  The  child’s  physiologic  and  psychic 
life  are  clear  indications  in  the  same  direction. 

Q.  Do  the  anthropoid  apes  resemble  man  in  this 
particular? 

A.  Yes.  While  the  young  anthropoid  is  compara¬ 
tively  human,  the  adult  ape  is  comparatively  bestial  in 
character.  The  young  ape  has  a  smooth,  globular 
head  and  relatively  small  face,  like  man.  The  profile 
is  more  human,  with  little  prognathism.  The  base  of 
the  skull  is  more  human  than  in  the  adult  ape.  The 
brain  i-s  relatively  much  larger  than  in  the  adult. 

Q.  What  is  the  case  with  the  gorilla? 

A.  The  foetus  differs  from  the  adult  by  having 
relatively  a  much  larger  head,  a  longer  neck,  more 
slender  trunk,  shorter  thumb  and  great  toe,  while  the 
head  is  more  globular,  the  face  less  prognathous,  and 
the  hand  more  man-like.  In  nearly  all  these  characters 
the  foetal  gorilla  approaches  man. 

Q.  What  becomes  of  the  male  ape  as  he  grows 
older? 


4 


49 


50 


QUIZ  COMPRND 


A.  The  adult  male  ape  rapidly  develops  into  a  con¬ 
dition  far  removed  from  his  early  man-like  state. 

Q.  What  changes  take  place? 

A.  The  brain  becomes  relatively  very  small,  the 
receding  skull  becomes  hideous,  with  huge  bony  crests, 
sharp  angles,  and  on  its  enormously  enlarged  facial 
portions,  prominent,  outstanding,  superciliary  ridges, 
projecting  jaws  and  receding  chin,  while  the  dark, 
hairy  body  becomes  more  bestial  in  character. 

Q.  How  is  the  female  affected? 

A.  She  remains  midway  between  the  infantile  and 
the  adult  male  condition. 

0.  When  do  man  and  the  apes  most  resemble  each 
other? 

A.  In  the  infantile  stage. 

Q.  How  do  they  differ  as  they  mature? 

A.  While  man, in  the  course  of  life,  falls  away  more 
and  more  from  the  specifically  human  type  of  infancy, 
the  ape,  in  the  course  of  his  short  life,  goes  very  much 
farther  along  the  road  of  degradation  and  premature 
senility.  The  ape  starts  in  life  with  a  considerable 
human  endowment,  but  in  the  course  of  life  falls  far 
away  from  it.  Man  starts  in  life  with  a  still  greater 
portion  of  human  or  ultra  human  endowment,  and  to 
a  less  extent  falls  from  it,  in  adult  life  approaching 
more  and  more  to  the  ape. 

Q.  From  conception  till  after  birth  is  there  a 
greater  change  in  zoologic  evolution? 

A.  Up  to  birth,  or  shortly  afterwards,  in  the  higher 
animals,  such  as  the  apes  and  man,  there  is  a  rapid 
and  vigorous  movement  along  the  line  upward  in 
zoologic  evolution. 


ON  IRREGULARITIES  OF  THE  TEETH.  51 

Q.  Is  there  a  time  when  this  foetal  and  infantile 
development,  ceases  to  be  upward  ? 

A.  The  time  comes  when  the  upward  development 
is  so  directed  as  to  answer  to- the  life  wants  of  the  par¬ 
ticular  species. 

Q.  What  develops  later  in  life? 

A.  Throughout  life  there  is  chiefly  a  development 
of  lower  characters,  a  slow  movement  towards  degen¬ 
eration  and  senility, although  one  absolutely  necessary 
to  insure  the  preservation  and  stability  of  the  individ¬ 
ual  and  species. 

Q.  What  occurs  during  fcetal  life? 

*  A.  Fcetal  evolution,-  which  takes:  place  sheltered 
from  the  world,  is  in  an  abstractly  upward  direction. 

Q.  What  occurs  after  birth  ? 

A.  After  birth  further  development  is  a  concrete 
adaptation  to  the-  environment  without  regard  to 
upward  zoologic  movement. 

Q.  What,  characteristics  of  humanity  are  found  in 
the  infant? 

A.  The  human  infant  presents,  in  an  exaggerated 
form,*  the  chief  distinctive: characteristics  of  humanity, 
the  . large  head  and  brain,  the  small  face,  the  hairless- 
ness,  the  delicate  bony  system. 

Q.  Which  has  the  best  chance  in  the  world,  from 
the  standpoint  of  environment? 

A.  From*  the  standpoint  of  adaptation  to  environ¬ 
ment  the  coarse,  hairy,  large-boned  and  small  brained 
gorilla  is  better  fitted  to  make  his  way  in  the  world 
than  the  delicate  offspring;  but  from  a  zoologic  point 
of  view  anything  but  progress  occurs. 

Q.  Are  the  first  years  in  man  of  rapid  growth? 

A.  From  about  (he  third  year  onward,  growth, 


52 


QUIZ  COMPEND 


though  absolutely  necessary,  adaptation  to  the  environ¬ 
ment  is  to  some  extent  growth  in  degeneration,  and 
senility.  This  is  not  carried  to  so  low  a  degree  as  in 
the  apes,  although  by  it  man  is  to  some  extent  brought 
nearer  to  the  apes. 

Q.  Does  the  progress  toward  senility  differ  in 
different  races? 

A.  Among  the  higher  human  races  the  progress 
toward  senility  is  less  marked  than  among  the  lower 
human  races. 

O.  How  does  the  negro  child  differ  - from  the 

,»  *.  a  •  ■» 

Caucasic  child?  -  •  - 

A.  The  negro  child  is  scarcely,  if  at  all,  less  intelli¬ 
gent  than  the  Caucasic  child. 

Q.  How  do  they  differ  as  they -grow  older? 

A.  The  negro,  as  he  grows  up,  however,  becomes 
more  stupid  and  obtuse,  and  his  whole  social  life  falls 
into  a  state  of  hide-bound  routine. 

Q.  How  does  the  Caucasic  race  develop? 

A.  It  retains  much  of  the  child-like  vivacity. 

Q.  Which  types  most  approximate  the  child? 

A.  The  highest  human  type  represented  in  typical 
man  of  genius,  strikingly  approximates  to  the  child 
type.  | 

Q.  What  great  factors  interfere  with  race  develop¬ 
ment? 

A.  The  great  factors  in  environment  which  inter¬ 
rupt  upward  race  progress  are  the  periods  of  stress. 

Q.  How  do  the  internal  actions  of  the  vertebrates 
affect  its  relations  to  environment? 

A.  Every  vertebrate  is  an  aggregate  ■«  whose 
internal  actions  are  adapted  to  counterbalance  its 
external  actions. 


ON  IRREGULARITIES  OF  THE  TEETH. 


53 


Q.  On  what  does  its  existence  depend? 

A.  Preservation  of  its  movable  equilibrium,  and 
hence  existence  depends  upon  its  development  and 
proper  number  of  these  actions. 

Q.  How  may  movable  equilibrium  be  ruined? 

A.  When  one  of  these  actions  is  too  great  or  too 
small  and  through  deficiency  or  need  of  some  organic 
or  inorganic  cause  in  its  surroundings. 

Q.  How  can  individuals  adapt  themselves  to  tnese 
chang.ed  influences? 

A.  In  two  ways,  either  directly  or  by  producing 
new  individuals  who  will  take  the  place  of  those  in 
whom  the  equilibrium  has  been  destroyed. 

Q.  Why? 

A.  Since  forces  exist  preservative  and  destructive 
to  the  race. 

O.  If  these  two  forces  do  not  counterbalance,  how  is 
equilibrium  established? 

A.  Since  it  is  impossible  that  these  two  varieties 
of  forces  should  counterbalance,  it  is  necessary  that  the 
equilibrium  should  re-establish  itself  in  an  orderly  way. 

Q.  What  are  these  two  preservative  forces? 

A.  The  impulse  of  every  individual  to  self-preser¬ 
vation,  and  the  impulse  to  the  production  of  other 
individuals.  These  must  vary  in  an  inverse  ratio,  and 
the  former  must  diminish  when  the  second  increases. 

Q.  What  does  degeneration  constitute? 

A.  A  process  of  disintegration. 

Q.  What  term  might  be  applied  to  all  processes 
which  complete  and  sustain  life? 

A.  Individuation. 

Q.  What  aids  the  formation  and  development  of 
new  individuals? 


54 


QUIZ  COMPEND 


A.  Generation. 

Q.  Are  these  terms  necessarily  antagonistic? 

A.  Yes. 

Q.  Do  vertebrate  embryos  at  the  outset  assume  a 
common  form? 

A.  Yes. 

O.  What  results  from  this? 

A.  Supernumerary  organs  and  the  repetition  of 
teratologic  types  in  vertebrates.  The  higher  verte¬ 
brate  embryo  contains  in  essence  the  organs  and  poten¬ 
tialities  of  all  the  lower  vertebrates.  Under  the  influ¬ 
ence  of  heredity  or  accidental  defect  an  organ  or 
structure  or  function  constant  in  a  species  may  be 
lacking  in  an  individual  without  the  necessity  of 
explaining  the  immediate  effects  by  distant  atavism. 

Q.  What  may  varying  environment  stimulate? 

A.  These  embryonic  potentialities  at  the  expense 
of  the  later  acquired  and  more  typic  human  organs. 

Q.  What  is  an  application  of  this  principle? 

A.  The  Cohnheim  theory  of  cancer. 

Q.  What  is  the  law  of  economy  of  growth? 

A.  A  fixed  supply  of  nutriment,  resulting  in  a 
struggle  for  existence  on  the  part  of  the  organs  and 
structures.  While  determination  by  heredity  exists 
there  are  always  surrounding  forces  necessary,  not 
simply  the  condition. of  activity  by  an  essential  ele¬ 
ment  of  the  final  product.  There  results  an  internal 
or  physiologic  struggle  for  existence  between  the 
organs,  the  cells  and  protoplasmic  molecules  of  the 
organism. 

Q.  How  does  this  unsimilarity  of  parts  affect 
heredity? 

A.  It  makes  it  impossible  to  establish  laws  which 


ON  IRREGULARITIES  OF  THE  TEETH. 


shall  govern  details  of  function  as  to  the  last  cell  or 
molecule,  since  in  any  army  the  commander-in-chief 
does  not  give  a  special  order  beforehand  affecting 
every  private  in  the  ranks. 

Q.  Must  there  be  potentiality  of  adaptation  to 
surroundings? 

A.  Yes. 

Q.  What  principle  lies  back  of  all  development 
of  tissues  or  organs? 

A.  Over-compensation  of  what  is  used,  a  quality 
which  permits  self-regulation  and  is  rarely  a  necessary 
pre-condition  of  life. 

Q.  What  does  living  matter  present? 

A.  An  external  continuity  in  spite  of  change  of 
condition. 

O.  If  the  assimilation  is  not  in  excess,  what  hap¬ 
pens? 

A.  If  less  than  consumption,  the  organism  comes 
to  an  end  itself. 

Q.  If  equal  conditions  result,  what  takes  place? 

A.  Change  and  nourishment  will  fail,  or  injurious 
events  will  cause  destruction. 

Q.  How  can  continuance  be  assured? 

A.  When  more  is  assimilated  than  is  consumed. 

Q.  Give  an  example. 

A.  Fire  assimilates  more  than  it  uses,  therefore  it 
always  has  energy  left  over  to  kindle  new  material. 

Q.  Do  organs  assimilate  more  than  they  consume? 

A.  Yes.  But  they  do  not  turn  all  they  use  to 
assimilation ;  energy  remains  over  by  which  the  process 
performs  something. 

Q.  What  does  this  work-product  control? 

A.  Excessive  assimilation,  which  otherwise  would 


.56 


QUIZ  COMPEND 


come  to  an  end  by  not  having  sufficient  material  to 
assimilate. 

Q.  What  are  the  more  complex  processes  of  life? 

A.  A  radiation  of  assimilation,  which  although  not 
identical  with  combustion  is  similar  to  it,  the  load 
which  it  carried  favoring  its  continuity. 

Q.  How  does  this  radiation  load  or  over-product 
become  directed? 

A.  By  natural  selection  to  keep  up  a  supply  of 
food,  primarily  by  moving  the  assimilating  mass. 

Q.  Is  performance  of  function  over  and  above 
assimilation  a  condition  of  continuous  assimilation, 
and  vice  versa? 

A.  Yes. 

Q.  Is  there  an  inverse  relationship  between  growth 
and  product? 

A.  Yes. 

Q.  Of  what  does  the  course  of  development  con¬ 
sist? 

A.  In  properly  directing  the  work-products. 

Q.  What  does  this  represent  so  far? 

A.  Merely  a  continuous  productibility  of  function 
in  connection  with  assimilation. 

Q.  A  productibility  which  is  stored  up  and  dis¬ 
charged  by  an  outer  stimulus  of  environment  will 
produce  what? 

A.  It  will  be  more- economic,  and  give  rise  to  what 
is  known  as  reflex  excitability. 

Q.  What  happens  when  this  reflex  product  domi¬ 
nates  according  to  circumstances? 

A.  Function  will  sometimes  be  greater  or  less. 

Q.  What  will  happen  under  these  conditions  if 
assimilation  continues? 


ON  IRREGULARITIES  OF  THE  TEETH. 


57. 


A.  There  must  sometimes  be  -an  overplus,  some¬ 
times  a  balance,  and  sometimes  an  excessive  function, 
death,  and  their  elimination. 

Q.  What  must  be  done  to  avoid  this  last? 

A.  It  is  necessary  that  assimilation  should  depend 
upon  use  or  upon  stimulus  which  use  calls  forth. 

Q.  From  the  psychic  side,  stimulus  is  recognized 
as  what? 

A.  Hunger. 

Q.  What  is  this  kind  of  process  where  stimulus  is 
an  indispensable  factor? 

A.  It  is  more  special  and  limited  than  the  more, 
general  process  of  assimilation  plus  movement,  etc., 
but  has  characteristics  which  favor  it  greatly  in  the 
struggle  tor  existence. 

Q.  How  is  the  greatest  saving  of  material  ob¬ 
tained? 

A.  By  the  most  complete  self-regulation  of  function- 
atio’n. 

Q.  What  becomes  of  the  parts  that  are  used? 

A.  They  are  strengthened  and  grow. 

Q.  What  becomes  of  the  parts  that  are  unused?  .  , 

A.  They  degenerate  and  the  material  for  their  sus¬ 
tenance  is  saved?  •  . 

Q.  How  does  the  union  of  the  greatest,  economy 
with  the  highest  functioning  of  the  whole  affect  the 
parts? 

A.  At  the  cost  of  the  independence  of  the  parts. 

Q.  What  is  the  result  of  differentiation? 

A.  Senescence,  in  which  the  parts  exist  merely 
on  account  of  the  function  which  they  perform  for. 
the  whole. 

Q.  What  fact  allows  a  fresh  start  in  development? 


QUIZ  COM  PEND 


58' 

A.  Thd  senescing  <  organ  withers  and  may  even 
descend  in  this  condition  from  generation  to  genera¬ 
tion. 

Q.  What  is  the  progress  of  the  organism  during  life? 

A.  The  organism  moves  from  a  more  general, 
more  easily  impressible,  condition  to  one  more  per¬ 
fectly  mechanized.  Through  a  long  period  it  becomes, 
through  the  continuous  working  of  a  given  stimulus, 
more  completely  adapted  to  itself  and  also  more  differ¬ 
entiated;  and  thereby  more  stable,  so  that  an  always 
increasing  opposition  is  formed  to  the  additional 
development  of  new  forms  and  characteristics. 

Q.  Does  the  law  of  economy  of  growth  hold  good? 

A.  Not  only  as  an  organic  unit  but  as  a  compound 
organism  even  as  a  social  unit. 

Q.  What  is  degeneracy? 

A.  Degeneracy  is  a  gradual  change  of  structure 
by  which  the  organism  becomes  adapted  to  less  varied 
and  complex  conditions  of  life. 

Q.  What  is  elaboration? 

A.  It  is  a  gradual  change  of  structure  by  which 
the  organism  becomes  adapted  to  more  varied  and 
complex  Conditions  of  existencer 

Q.  What  occurs  in  elaboration? 

A.  There  is  a  new  condition  of  form  corresponding 
to  new  perfection  of  work  in  the  animal  mechanism. 

Q.  What,  in  degeneracy? 

A.  In  degeneracy  there  is  a  suppression  of  form 
corresponding  to  the  cessation  of  work. 

Q.  Are  elaboration  and  degeneracy  ever  found  in 
one  individual? 

A.  Elaboration  of  some  one  organ  may  be  a  nec¬ 
essary  accompaniment  of  degeneracy  in  all  the  Others. 


ON  IRREGULARITIES  OF  THE  TEETH.  59 

Q.  Does  this  often  occur? 

A.  It  is  very  generally  the  case. 

Q.  When  can  the  individual  •  be  regarded  as  an 
instance  of  degeneracy? 

A.  Only  when  the  total  results  of  the  elaboration 
of  some  organ  and  the  degeneracy  of  others  is  such 
as  to  leave  the  whole  mass  in  a  lower  condition,  that 
is  fitted  to  less  complex  action  and  reaction  to  its  sur- 
roundings  than  is  the  type. 

Q.  Since  degeneracy  is  a  process  of  evolution,  lead¬ 
ing  to  alteration  of  form  because  of  cessation  of  inhi¬ 
bition  in  certain  directions  resultant  on  diminished 
work,  what  follows? 

A.  Since  diminishing  functionating  precedes 
change  of  structure,  increased  functionating  must 
check  the  change  of  structure  in  its  biologic 
stage. 

Q.  Why  do  the  degenerate  races  sometimes  rise 
higher  in  evolution? 

A.  Because  of  the  utilization  of  the  beneficial 
varieties  due  to  degeneracy. 

Q.  Why  is  the  influence  of  this  principle  increased? 

A.  Because  the  majority  of  children  of  degenerates 
inherit  a  tendency  to  degeneracy  rather  than  degen¬ 
eracy  itself. 

Q.  Can  structural  elaboration  due  to  degeneracy 
be  retained? 

A.  It  is  evident  that  structural  elaboration  due  to 
degeneracy  may  be  retained  while  the  degenerate 
structures  resume  their  higher  functions. 

Q.  Upon  what  do  intra-uterine  periods  of  stress 
depend? 

A.  Since  certain  parts  disappear  in  the  evolution 


60 


QUIZ  COMPEND 


of  organs,  and  certain  organs  during  the  evolution  of 
organisms,  and  since  the  disappearance  and  develop¬ 
ing  tendency  must  center  around  the  time  when  cer¬ 
tain  functions  will  be  lost  by  the  disappearing  and 
others  gained  by  the  developing,  periods  of  stress  must 
occur,  around  which  the  law  of  economy  of  growth 
will  center,  the  struggle  for  existence  between  the 
parts  of  organs  and  between  the  organs. 

Q.  When  are  the  struggles  for  existence  on  the 
part  of  the  different  organs  and  systems  of  the  body 
most  intense? 

A.  During  the  periods  of  intra-  and  extra-uterine 
evolution  and  involution. 

Q.  When  are  these  periods? 

A.  During  the  first  dentition,  during  the  second 
dentition  (often  as  late  as  the  thirteenth  year),  during 
puberty  and  adolescence  (fourteenth  to  twenty-fifth), 
during  the  climacteric  (fortieth  to  sixtieth),  when 
uterine  involution  occurs  in  women  and  prostatic 
involution  in  man,  and  finally,  during  senility 
(sixtieth  and  upwards),  mental  or  physical  defects  may 
occur,  a  congenital  tendency  to  which  has  remained 
latent  until  the  period  of  stress. 

Q.  When  systematic  balance,  the  result  of  evolution 
is  disturbed  by  change  in  environment,  what  takes 
place? 

A.  The  organs  do  not  pursue  their  usual 
growth. 

Q  When  are  such  disturbances  apt  to  occur? 

A.  They  are  peculiarly  liable  to  occur  during 
periods  of  stress,  because  of  the  then  varying  relation 
of  the  different  organs. 

Q  What  is  the  weight  of  the  brain  during  the  first 


ON  IRREGULARITIES  OF  THE  TEETH.  61 

m 

extra-uterine  period  of  stress  between  birth  and  three 
months? 

A.  It  is  one-fifth  the  weight  of  the  body,  while  in 
the  adult  it  is  but  one  thirty-third. 

Q.  How  does  the  brain  grow  during  the  first  six 
months? 

A.  It  doubles  in  weight. 

Q.  What  would  be  the  effect  of  stress  during  this 
period? 

A.  Under  the  law  of  economy  of  growth,  it  would 
either  be  felt  in  diminution  of  quality  or  quantity  of 
the  brain  or  the  preservation  of  these  at  the  expense 
of  more  transitory  structures. 

Q.  What  structure  would  be  likely  to  become 
involved? 

A.  The  jaws,  alveolar  process,  and  teeth. 

Q.  During  the  period  between  two  years  and  six, 
what  would  take  place? 

A.  The  same  factors,  to  a  lessened  degree,  are 
present,  while  between  seven  and  fourteen  the  brain 
has  quadrupled  in  weight. 

Q.  What  is  the  size  of  the  heart  at  birth? 

A.  It  is  small,  relatively  to  the  arterial  system, but 
this  disproportion  gradually  disappears  until  at 
puberty,  when  the  relation  is  changed. 

Q.  What  advantages  has  a  heart  relatively  larger 
in  regard  to  the  blood  vessels? 

A.  The  higher  the  blood  pressure,  the  earlier, 
stronger  and  more  complex  the  development  of 
puberty. 

Q.  What  is  the  weight  of  the  heart  from  birth  on¬ 
wards? 

A.  It  increases  twelve  and  one-half  times. 


C2 


QUIZ  COMPEND 


/ 


Q.  What  occurs  from  strain  during  this  period? 

A.  Strain  interfering  with  heart  growth  would 
either  affect  it, or  under  the  law  of  economy  of  growth 
the  more  transitory  structures  for  its  benefit. 

Q.  What  do  periods  of  stress  resemble? 

A.  To  a  certain  extent  periods  of  stress  resemble 
ancestral  states. 

Q.  Do  these  periods  summarize  ancestral  progress? 

A.  Yes.  Evolution  may  take  pla«e  without  leaving 
traces  of  the  various  stages. 

Q.  Where  is  this  most  noticeable? 

A.  In  complex  organs  which  have  been  produced 
by  many  lines  of  evolution  converging  in  a  single 
structure ;  a  structure  which  thus  becomes  the  seat 
of  a  special  function  or  set  of  functions. 

Q.  Give  an  example. 

A.  The  neuron,  for  instance,  the  nerve-cell  unit  of 
the  human  brain  cortex,  passes  successively  through 
stages  corresponding  to  those  which  are  to  be  found 
in  adult  fish,  frog,  bird,  and  mammal. 

O.  Wherein  does  development  appear? 

A.  In  an  increasing  complexity  of  the  cell,  with  no 
formation  of  unnecessary  rudimentary  parts. 

Q.  Does  this  appear  in  man? 

A.  Yes.  When  the  human  brain  development  is 
compared  with  the  probable  ancestral  stages  evident 
in  the  vertebrate  series. 


CHAPTER  V. 


DEVELOPMENT  OF  THE  CRANIUM  AND  FACE. 

Q.  How  is  the  human  skull  developed? 

A.  It  has  a  double  origin.  There  are  really  two 
skulls,  one  inside  of  the  other. 

Q.  Were  these  originally  distinct? 

A.  Yes,  but  in  the  process  of  evolution  the  union 
between  them  became  more  and  more  intimate. 

Q.  Wherein  is  this  development  evident? 

A.  In  the  changes  which  embryologically  occur  in 
man. 

Q.  What  is  the  primary  skull? 

A.  It  is  practically  an  extension  of  the  vertebrae, 
which  send  out  side  growths  to  cover  the  brain,  as  the 
backbone  covers  the  spinal  cord. 

Q.  Describe  this  process. 

A.  The  primary  skull  extends  in  front  of  the 
notochord  (the  spinal  cord  of  the  human  embryo  and 
the  permanent  spinal  cord  of  the  lancelet),  where  it 
gives  off  two  trabeculae  cranii  (front  skull  plates). 
Behind  it,  the  primary  skull  or  chondrocranium  gives 
off  two  occipital  or  rear  skull  plates.  It  also  gives  off 
two  plates  (midway  between  the  trabeculae  and  occi- 
pitals),  which,  as  they  gradually  enclose  the  primitive 
hearing  apparatus  (the  otocysts,  permanent  in  fish  and 
embryonic  in  man)  are  called  periotic  capsules. 

Q.  What  is  the  nature  of  this  primary  skull? 

A.  It  is  at  first  cartilaginous,  as  in  sharks. 

Q.  What  occurs  in  consequence  of  increase  in  the 

63 


64 


QUIZ  COMPEND 


size  of  the  brain  in  evolution  and  in  human  embry¬ 
ology? 

A.  This  cartilaginous  primary  skull  becomes  insuf¬ 
ficient  to  roof  over  the  brain,  and  thus  are  produced 
the  gaps  called  fontanels,  which  are  the  result  of 
failure  of  the  chondrocranium  (primary  skull),  to 
cover  the  gains  of  the  nervous  system  in  the  struggle 
for  existence. 

Q.  How  is  this  deficiency  overcome? 

A.  The  skin  of  the  mammal  retained  a  bone 
making  function  inherited  from  the  reptiles  and  bony 
fishes. 

Q.  How  were  these  cavities  filled? 

A.  With  dermal  bones,  which,  at  first  serving 
merely  as  armour  in  the  skin  of  the  head,  came  ulti¬ 
mately  to  be  protectors  of  the  nervous  system. 

Q.  What  bones  represent  the  dermal  bones  in  the 
embryonic  human  skull? 

A.  The  frontals,  whose  sutures  normally  disappear 
in  the  adult,  so  that  the  forehead  seems  to  be  but  one 
bone.  This  union  may  not  occur  when,  as  in  the  case 
of  the  philosopher  Kant,  the  frontal  suture  remains 
during  life.  The  sutures  are  replaced  by  solid  bone 
through  synostosis.  In  the  frontal  bone,  synostosis  is 
normal,  and  in  the  line  of  advance.  Elsewhere  in  the 
skull  it  is  often  an  expression  of  a  premature  senility 
that  may  give  rise  to  various  cranial  states  either 
absolutely  degenerate  in  type  or  degenerate  only  when 
present  in  certain  races.  The  parietals  and  inter- 
parietals  are  dermal  bones  so  united  by  synostosis  as 
to  form  the  parietals  or  side  bones  of  the  normal  adult 
skull. 

Q.  What  other  bones  of  the  head  are  dermal  bones? 


ON  IRREGULARITIES  OF  THE  TEETH. 


65 


A.  The  nasal  bones,  which,  together  with  the 
vomer,  form  the  nose,  are  likewise  dermal  bones,  and 
so  are  the  pterygoids  and  palatines.  The  maxillaries 
and  praemaxillaries,  which  (with  the  mandibles)  form 
the  jaws,  are  dermal  bones.  The  mandibles  are  in 
part  derived  from  the  chondrocranium. 

Q.  What  becomes  of  the  mouth  cavity  in  the  head 
bend  of  the  embryo? 

A.  It  is  brought  between  the  forehead  and  the 
heart  and  upon  the  ventral  surface. 

Q.  Upon  what  does  the  development  of  the  face 
depend? 

A.  The  enlargement  and  fusion  of  the  mouth  and 
nose  cavities,  and  upon  the  later  partial  separation  of 
the  nose  and  mouth  and  nose  cavities,  leaving  the 
posterior  nose  open. 

Q.  On  what  does  it  depend  further? 

A.  The  growth  and  specialization  of  the  face 
region,  of  which  elongation  is  the  most  prominent 
indication,  and  finally  upon  the  development  of  a 
prominent  external  nose. 

Q.  What  takes  place  when  the  medullary  tube  of 
the  notochord  enlarges  to  form  the  brain? 

A.  The  head  bends  over  to  make  room  for  that 
enlargement. 

Q.  What  becomes  of  the  mouth  plate  in  the  bend¬ 
ing  of  the  head? 

A.  The  mouth  plate,  which  is  to  be  the  mouth,  is 
carried  over  to  the  front  of  the  head. 

Q.  What  changes  take  place  in  the  development  of 
the  mouth  cavity? 

A.  The  growth  of  the  brain  and  increase  in  size  of 


66 


QUIZ  COMPEND 


the  heart  cavity,  which  expands  in  front,  leaving  the 
mouth  cavity  between  them. 

Q.  What  does  the  mouth  cavity  represent? 

A.  Two  gill-slits  united  in  the  front  line. 

Q.  How  is  the  nose  formed? 

A.  The  nose  is  formed  from  two  olfactory  plates, 
situated  just  in  front  of  the'  mouth,  and  in  contact 
with  the  fore  brain. 

Q.  How  do  these  olfactory  plates  grow? 

A.  They  grow  in  size  by  the  increase  of  tissue, 
and  the  resulting  pits  pass  away  from  the  brain. 

Q‘.  With  what  do  these  pits  communicate? 

A.  Freely  with  the  mouth. 

Q.  What  do  the  nasal  processes  include? 

A.  The  origin  of  the  future  nose  and  the  future 
intermaxillary  region  of  the  upper  lip. 

Q.  How  are  the  nasal  pits  developed? 

A.  By  the  upgrowth  of  the  ectoderm  and  meso¬ 
derm  and  the  olfactory  plate. 

Q.  Where  does  the  upgrowth  take  place? 

A.  On  the  medial,  upper  and  lateral  side  of  each 
plate,  and  hence  forms  two  pits  with  a  partition  (the 
future  nasal  septum)  between  them. 

Q.  How  do  the  nasal  pits  communicate? 

A.  Along  their  whole  lower  side,  directly  with  the 
mouth  cavity.  The  nasal  pit  is  at  first  very  shallow. 

Q.  How  many  changes  are  there  during  their 
growth? 

A.  Two.  First,  growth  of  the  tissue  occurs  around 
the  olfactory  plate,  and  then  the  pits  migrate  away 
from  the  brain. 

Q.  How  are  the  nasal  pits  separated? 

A.  By  a  projecting  mass  of  tissue,  called  the  nasal 


ON  IRREGULARITIES  OE  THE  TEETH.  (57 

process,  which  includes  the  partition  between  the  two 
nasal  chambers  in  outline  of  the  future  nose  and  of 
the  future  intermaxillary  region  of  the  upper  lip. 

Q.  Where  does  the  maxillary  process  extend? 

A.  Between  the  mouth  and  eye,  toward  the  nasal 
pit,  and  by  joining  the  rounded  end  of  the  nasal  pro¬ 
cess,  begins  the  separation  of  the  nasal  and  buccal 
chambers  and  completes  the  upper  border  of  the 
mouth. 

Q.  What  takes  place  as  development  proceeds? 

A.  The  lateral  ridge  grows  forward  and  covers  in 
the  nasal  pit  from  the  sides,  forming  the  outline  of 
the  wing  of  the  adult  nose.  There  are  now  two 
external  nares. 

O.  Do  the  nasal  chambers  enlarge? 

A.  They  enlarge  as  the  whole  •  face  enlarges,  and 
occupy  an  increasing  space,  opening  widely  into  the 
mouth  cavity  above  the  palate  split. 

Q.  From  what  is  the  so-called  labyrinth  of  the 
nose  formed? 

A.  From  the  nasal  pits  proper. 

Q.  When  does  it  begin  to  develop? 

A.  It  begins  with  the  appearance  (third  month  of 
embryonic  life)  of  three  projecting  folds  on  the  lateral 
wall  of  each  nasal  chamber. 

Q.  What  are  they  called? 

A.  Upper,  middle,  and  lower  turbinal  folds.  They 
very  early  contain  cartilage. 

Q.  How  does  the  formation  of  the  labyrinth 
advance? 

A.  By  the  formation  of  the  outgrowths,  which 
become  the  ethmoidal  sinuses  by  the  appearance,  dur¬ 
ing  the  sixth  month,  of  the  antrum  of  Highmorii,  or 


QUIZ  COMPEND 


expansion  of  the  nasal  cavity  into  the  region  of  the 
superior  maxillary/  and  finally  by  evaginations  to 
form  the  sphenoidal  and  frontal  sinuses,  which,  how¬ 
ever,  do  not  arise  in  man  until  after  birth.  The  sepa¬ 
ration  of  the  olfactory  plate  from  the  brain  does  not 
take  place  until  the  olfactory  ganglion  develops  from 
the  epithelium. 

Q  When  does  the  separation  of  the  olfactory  plates 
from  the  brain  take  place? 

A.  Not  until  the  olfactory  ganglion  develops  from 
tne  epitnelium.  The  fibers  lengthen,  the  olfactory 
and  neural  epithelium  separate  and  finally  osseous 
cribriform  plate  is  developed  between  them. 

Q.  When  does  the  external  nose  develop? 

A.  Toward  the  end  of  the  second  month  of  embry¬ 
onic  life  by  a  growth  of  the  nasal  process. 

Q.  What  is  the  shape  of  the  external  nose  at  the 
third  month  of  embryonic  life? 

A.  It  is  at  first  short  and  broad,  having  very  nearly 
the  shape  which  is  permanent  in  certain  negro  races. 
Later  the  external  nares  and  wings  of  the  nose  are 
carried  forward  with  a  general  nasal  upgrowth. 

Q.  What  takes  place  as  soon  as  the  external  nose 
is  separated  from  the  mouth? 

A.  There  is  a  partition  between  the  nasal  pits  and 
the  mouth. 

Q.  How  is  the  upper  part  of  the  mouth  covering 
formed? 

A.  The  partition  in  which  the  intermaxillary  bone 
is  differentiated  later,  is  supplemented  by  another  par¬ 
tition.  the  true  palate,  which  shuts  off  the  upper  part 
of  the  mouth  cavity  from  the  lower,  thus  adding  the 
upper  part  of  the  nose  chambers. 


ON  IRREGULARITIES  OF  THE  TEETH. 


69 


Q.  What  is  the  palate? 

A.  It  is  a  secondary  structure,  which  divides  the 
mouth  into  an  upper  respiratory  passage  and  a  lower 
lingual  or  digestive. 

Q.  How  is  the  palate  developed? 

A.  The  palate  arises  as  two  shelf-like  growths  of 
the  inner  side  of  each  maxillary  process  and  is  com¬ 
pleted  by  union  of  the  two  shelves  in  the  median  line. 

Q.  How  are  these  arched? 

A.  So  as  to  descend  a  certain  distance  into  the 
pharynx. 

Q.  Are  these  growths  arrested? 

A.  Yes,  though  they  may  be  still  recognized  in  the 
adult. 

Q.  Where  do  the  palate  shelves  continue  growing? 

A.  In  the  region  of  the  tongue,  which,  rising 
between  them,  seems  in  sections  which  pass  through 
the  internal  nares,  to  be  about  to  join  the  internasal 
septum. 

Q.  What  becomes  of  the  tongue  as  the  lower  jaw 
grows? 

A.  The  floor  of  the  mouth  is  lowered,  and  the 
tongue  is  thus  brought  further  away  from  the  inter¬ 
nasal  septum. 

Q.  What  becomes  of  the  palate  shelves.? 

A.  They  take  a  more  horizontal  position  and  pass 
toward  one  another,  above  the  tongue,  and  below  the 
nasal  septum  to  meet  in  the  middle  line,  where  they 
unite. 

O.  How  do  the  shelves  unite? 

A.  From  their  original  position,  the  shelves  nec¬ 
essarily  meet  in  front  toward  the  lip  first,  and  unite 
behind  toward  the  pharynx  later. 


70 


OUIZ  COM  PEND 


Q.  What  time  do  they  unite  in  the  human  embryo? 

A.  Union  begins  at  the  eighth  week,  and  is  com¬ 
pleted  by  the  ninth  for  the  hard  palate,  and  by  eleven 
weeks  for  the  soft. 

Q.  Where  do  the  palate  shelves  extend? 

A.  Back  across  the  second  and  third  brachial  arches. 

Q  What  time  does  the  uvula  appear? 

A.  During  the  latter  half  of  the  third  month,  as  a 
projection  of  the  border  of  the  soft  palate. 

Q.  When  does  the  nasal  septum  unite  with  the 
palate? 

A.  Soon  after  the  palate  shelves  have  united  with 
one  another,  the  nasal  septum  unites  with  the  palate 
also,  and  thereby  the  permanent  or  adult  relation  of 
the  cavities  are  established. 

Q.  What  value  is  degeneracy  of  the  face? 

A.  The  fact  that  the  human  face  is  modified  back¬ 
ward  from  the  vertebrate  type  excellently  illustrates 
the  degeneracy  of  a  series  of  related  structures  for  the 
benefit  of  the  organism  as  a  whole. 

Q.  Why  is  the  process  of  development  of  the  ver¬ 
tebrate  face  checked  in  man? 

A.  Because  the  upright  position  renders  it  unnec¬ 
essary  to  bend  the  head,  as  in  quadrupeds,  and  because 
the  enormous  cerebral  development  has  rendered  an 
enlargement  of  the  brain  cavity  necessary. 

Q.  How  has  this  taken  place? 

A.  By  extending  the  brain  cavity  over  the  nose 
region  as  well  as  by  enlarging  the  whole  skull. 
Because  development  of  the  face  is  arrested  at  an 
embryonic  stage.  The  production  of  a  long  snout  is 
really  an  advance  of  development,  which  does  not 
occur  in  man. 


ON  IRREGULARITIES  OF  THE  TEETH. 


71 


Q.  What  depends  upon  the  variations  of  the  dermal 

bones? 

•  » 

A.  Not  only  the  race  variations  in  skull  and  jaw 
types,  but  also  the  variations  produced  by  agencies 

acting  on  the  individual  during  the  periods  of  bodily 

* 

stress  and  by  the  degenerative  influences. 

Q.  What  do  craniologists  generally  assume? 

A.  Two  fundamental  skull  types,  dolichocephalous, 
or  long-headed,  and  brachycephalous,  or  round- 
headed. 

Q.  How  are  these  types  determined? 

A.  By  the  so-called  cephalic  index,  which  is  deter¬ 
mined  by  the  relation  of  the  antero-posterior  diameter 
(measured  from  the  glabella  to  the  farthest  point  of 
the  occiput)  to  the  transverse  diameter  from  side  to 
side.  The  former  being  taken  at  ioo,  the  latter  will 
range  from  about  60  to  95,  or  even  more,  increasing 
with  the  greater  degree  of  brachycephaly  and  vice 
versa. 

Q.  What  are  the  extremes,  excluding  artificial 
deformities? 

A.  Excluding  artificial  deformation,  the  extremes 
appear  to  lie  letween  61.9  (Fijian,  measured  by 
Flower)  and  98.21  (a  Mongolian,  described  by  Huxley). 
This  last  approaches  the  perfect  circle,  which  is  never 
presented  by  the  normal  head,  though  exceeded 
(103- 1 05)  by  pathologic,  teratologic  or  deformed 
specimens. 

O.  What  are  most  people  now? 

A.  Most  people  are  now  mesaticephalous  and  hence 
of  mixed  descent. 

Q.  When  did  race  intermingling  begin? 

A.  In  the  neolithic  period. 

6 


72 


QUIZ  COMPEND 


Q.  Is  the  horizontal  index  greater  or  less  .than  it 
was? 

A.  It  is  considerably  less  in  the  primary  than  in  the 
secondary  divisions  of  mankind. 

Q.  Are  there  exceptions? 

A.  The  alleged  normal  dolichocephaly  of  African 
negroes  has  numerous  exceptions.  The  Eskimo,  who 
seemingly  ought  to  be  brachycephalic,  are  extremely 
dolichocephalic. 

Q.  To  meet  the  endless  transitions  between  the 
two  extremes,  what  table  did  Broca  devise? 

A.  i.  Dolichocephali,  with  index  No.  75  and  under. 

2.  Sub-dolichocephali,  with  index  No.  75.10  to 

77-  77* 

3.  Mesaticephali,  with  index  No.  77.78  to  80. 

4.  Sub-brachycephali,  with  index  No.  80. 10  to 

83.83. 

5.  Brachycephali,  with  index  No.  83.34  up¬ 

wards. 

Q.  What  cranial  measurement  is  of  great  import¬ 
ance  to  the  dentist? 

A.  That  which  determines  the  varying  gnathism 
or  greater  or  less  projection  of  the  upper  jaw,  which 
depends  upon  the  angle  made  by  the  whole  face  with 
the  brain  cap. 

Q.  How  is  this  applied? 

A.  The  more  obtuse  the  angle  the  greater  will  be 
the  maxillary  projection  (prognathism),  the  more  ver¬ 
tical  the  face  the  less  the  projection  (orthognathism) ; 
hence  gnathism  (best  seen  in  profile),  as  indicated  by 
the  facial  angle,  is  accepted  by  anthropologists  as  a 
race  criterion. 


ON  IRREGULARITIES  OF  THE  TEETH. 


73 


Q.  What  has  been  the  effect  of  evolution  upon  the 
face? 

A.  The  evolution  (intimately  associated  with  the 
dentition  and  change  from  raw  to  cooked  food)  has 
been  from  the  extreme  projection  of  the  higher  apes 
and  of  primitive  man  to  the  seemingly  vertical  posi¬ 
tion  of  the  Mongolic  and  Caucasic  groups. 

Q.  What  does  prognathism  and  orthognathism 
indicate? 

A.  Prognathism  is  hence  characteristic  of  the  lower 
and  orthognathism  of  the  higher  races. 

Q.  Give  an  illustration. 

A.  The  profile  of  the  Calmuck  face  is  almost  ver¬ 
tical,  the  facial  bones  being  thrown  downwards  and 
under  the  forepart  of  the  skull.  The  profile  of  the 
face  of  the  negro  is  differently  inclined;  the  front  part 
of  the  jaws  projecting  far  forward  beyond  the  level 
of  the  fore  part  of  the  skull.  In  the  former  the  skull 
is  orthognatous,  or  straight-jawed,  in  the  latter  it  is 
prognathous. 

Q.  What  other  features  have  been  added? 

A.  Combining  this  feature  with  eurygnathism  (that 
is,  lateral  projection  of  the  cheek  bones)  the  Caucasic 
face  is  oval  with  vertical  jaws,  the  Mongolic  broad 
(eurygnathous),  the  negro  prognathous,  and  the  Hot¬ 
tentot,  both  pro  and  eurygnathous. 

O.  How  does  Topinard  distinguish  between  a 
superior  and  anterior  angle? 

A.  The  former  (general  facial  gnathism)  is  falla¬ 
cious  as  a  guide ;  the  latter  (that  is,  sub-nasal  gnath¬ 
ism,)  being  trustworthy. 

Q.  How  have  anthropologists  erred? 

A.  By  giving  so  much  importance  to  the  projec- 


74 


QUIZ  COMPEND 


tion  of  the  whole  maxilla,  or  the  whole  face.  There 
is  no  uniformity  of  results  in  a  given  case.  The  most 
flagrant  contradiction  occurs  between  averages  in 
allied  races. 

Q.  What  is  the  best  method  of  measurements? 

A.  The  sub-nasal,  or  true  prognathism,  furnishes 
the  differential  character  of  the  various  human  types. 

Q.  How  are  these  determined? 

A.  By  the  angle  formed  by  a  line  drawn  from 
the  nasal  spine  (sub-nasal  point)  to  the  anterior 
extremity  of  the  alveolo-condylean  plane. 

O.  What  does  this  plane  give? 

A.  The  total  projection  of  the  skull  is  about  par¬ 
allel  with  the  horizontal  line  of  vision,  coinciding  with 
a  line  drawn  from  the  alveolar  point  (medium  point  of 
the  alveolar  arch)  at  right  angles  to  a  perpendicular 
line  falling  from  the  occipital  condyles. 

Q.  Give  a  few  illustrations? 

A.  Individual  extremes,  89  to  5  *.3. 

White  races,  82  to  76.5. 

Yellow  races,  76  to  69.5. 

Black  races,  69  to  59.5. 

O.  What  does  this  indicate? 

A.  From  this  it  is  evident  that  absolute  orthogna¬ 
thism  does  not  exist. 

Q.  What  is  the  gnathism  of  most  of  the  races? 

A.  All  are  more  or  less  prognathous,  the  European 
least,  the  negro  most,  the  Mongol  and  Polynesian 
intermediate.  In  Europe  the  most  orthognathous 
were  the  Gauls,  Corsicans  and  Neolithic  men.  The 
Finns  were  the  least. 

Q.  What  does  orthognathism  mean  in  anthro¬ 
pology? 


ON  IRREGULARITIES  OF  THE  TEETH. 


75 


A.  As  the  term  is  used  in  anthropology,  it  simply 
applies  to  the  sub-nasal  type. 

Q.  What  other  factors  in  dentistry  must  be  taken 
into  account? 

A.  The  relation  of  the  inferior  maxilla  must  like¬ 
wise  be  taken  into  consideration,  since  around  this 
,  turns  the  struggle  for  existence  between  the  jaws  and 
teeth. 


i 


CHAPTER  VI. 


DEVELOPMENT  OF  THE  JAWS. 

Q.  Where  does  the  vertebrate  mouth  belong  in  the 
primitive  stage? 

A.  On  the  under  side  of  the  head. 

Q.  How  do  constitutional  disorders  and  infectious 
diseases  influence  growth  and  development  of  the 
maxillaries? 

A.  The  hypophysis,  or  pituitary  body,  has  much 
to  do  with  the  osseous  development  of  the  body.  If  it 
be  affected,  anomalies  result. 

Q.  How  does  this  affect  the  jaws? 

A.  Since  the  face,  including  the  jaws,  are  trans¬ 
itory  structures,  changed  glandular  action  may  pro¬ 
duce  either  excessive  or  arrest  of  development. 

Q.  To  determine  jaw  width,  where  are  measure¬ 
ments  taken? 

A.  From  the  outer  surface  of  one  first  permanent 
molar  to  the  outer  surface  of  the  other. 

Q.  Why  at  that  locality? 

A.  Because  the  first  permanent  molar  erupts  at  the 
sixth  year.  It  is  developed  independently  of  the  other 
teeth.  It  is  a  fixture  in  the  jaw,  and  it  gives  the  most 
accurate  width,  being  situated  midway  from  before, 
backward. 

Q  When  are  the  best  results  obtainable? 

A.  Between  twenty-five  and  thirty-five. 

Q.  Why? 


i 


11 


78 


QUIZ  COMPEND 


A.  Because  the  jaws,  like  the  rest  of  the  body, 
continue  to  grow  until  that  period. 

Q.  Why  is  such  a  wide  distinction  made  in  the 
ages? 

A.  A  normal,  healthy  individual  usually  obtains 
his  growth  at  twenty-five.  A  neurotic  or  degenerate 
may  not  obtain  his  growth  until  thirty-five. 

Q.  What  instrument  is  used  to  obtain  these 
measurements? 

A.  The  ordinary  mechanical  callipers. 

Q.  Do  jaws  differ  in  size  in  different  races  and 
peoples? 

A.  Yes. 

Q.  Why? 

A.  All  things  considered,  the  size  of  the  jaws 
correspond  with  the  size  of  the  bony  framework. 
This,  however,  only  holds  true  so  far  as  the  primitive 
races  are  concerned. 

Q.  How  about  modern  and  mixed  races? 

A.  Owing  to  inheritance,  to  disease,  to  climate, 
soil,  and  environment  changes,  excessive  and  arrested 
development  occurs,  modifying  the  size  of  the  jaws. 

Q.  Give  examples. 

A.  The  jaws  of  the  European  races  are  larger  than 
those  of  the  European-American.  The  jaws  of  the 
American  Indian  are  larger  than  those  of  the  English 
or  American.  The  jaws  of  peoples  living  in  the  older 
parts  of  the  American  Continent  are  smaller  than  in 
the  newer  parts. 

Q.  Of  what  does  the  antero-posterior  diameter  con¬ 
sist? 

A.  The  distance  at  the  median  line  from  a  line 
drawn  across  from  the  posterior  surface  of  the  last 


79 


ON  IRREGULARITIES  OF  THE  TEETH 

molars  to  the  anterior  alveolar  process  between  the 
central  incisors. 

Q.  How  do  the  jaws  of  the  female  compare  in  size 
with  those  of  the  male? 

A.  Those  of  the  female  are  smaller. 

Q.  How  is  room  secured  for  the  eruption  of  the 
second  and  third  molars? 

A.  The  development  of  the  jaws  is  from  before,  • 
backward. 

Q.  What  effect  has  human  evolution  upon  the  jaws 
and  face? 

A.  It  arrests  development.  The  jaws  are  growing 
shorter. 

Q.  Under  what  circumstances  does  marked  arrest 
take  place? 

A.  In  cases  where  there  is  an  unstable  nervous 
system.  It  also  frequently  occurs  from  exanthema¬ 
tous  diseases. 

Q.  What  local  condition  will  arrest  jaw  develop¬ 
ment? 

A.  Premature  extraction  of  the  first  permanent 
molars. 

Q.  What  effect  does  this  have  upon  the  jaws? 

A.  The  jaws  shortening  naturally  from  an  evolu¬ 
tionary  standpoint,  and  developing  backwards  suffi¬ 
ciently  merely  to  receive  the  second  and  third  molars,  the 
removal  of  the  first  permanent  molar  allows  the  second 
and  third  (should  there  be  one)  to  move  forward. 

Q.  What  other  local  conditions  will  arrest  jaw 
development? 

A.  When  the  child  inherits  small  teeth  from  one  or 
the  other  parent,  or  when  the  child,  owing  to  disease, 
develops  teeth  smaller  than  normal. 


80 


QUIZ  COMPEND 


Q.  Under  what  conditions  do  the  jaws  differ  in 
normal  individuals? 

A.  Two  types  of  jaws  are  observed :  in  brachyceph- 
alic  the  broad,  square  jaws;  in  dolichocephalic,  the 
long,  narrow  jaws. 

Q.  Do  these  comparisons  always  exist? 

A.  No.  Only  in  relatively  pure  races. 

Q.  Why  not? 

A.  Because  the  tendency  of  both  extremes  is 
towards  the  mesocephaly.  Should  a  long-headed  per¬ 
son  marry  a  round-headed  individual,  the  offspring 
might  have  a  round  head  and  long  jaws,  another  a 
long  head  and  a  square  jaw. 

Q.  What  is  the  law  of  economy  of  growth? 

A.  It  is  that  law  whereby  an  organ  or  structure 
is  sacrificed  for  the  benefit  of  the  organism  as  a 
whole. 

Q.  Give  illustrations. 

A.  The  vermiform  appendix  was  much  larger  and 
longer  in  lower  mammals.  It  was  used  to  assist  veg¬ 
etable  digestion.  Now  it  is  not  required,  and  is  dis¬ 
appearing.  The  muscles  of  the  ear  are  largely  devel¬ 
oped  in  the  lower  animals  to  move  the  ear  in  different 
directions.  In  man  they  are  not  required.  The  jaws 
and  teeth  in  early  races  were  used  for  grinding  foods. 
Now  food  is  cooked  soft..  Large  teeth  and  jaws,  with 
powerful  muscles,  are  not  required.  In  these  cases 
and  many  others  under  this  law,  unnecessary  organs 
and  structures  are  disappearing. 

Q.  Do  the  jaws  of  peoples  whose  ancestors  have 
long  lived  in  a  given  environment  differ  in  size? 

A.  They  do  not. 

Q.  Why? 


ON  IRREGULARITIES  OF  THE  TEETH. 


81 


A.  Because  they  are  reduced  almost  to  their  lowest 
size  without  causing  deformity. 

Q.  What  difference  exists  between  jaws  of  ancient 
Britons  and  Romans  and  those  of  modern  English  and 
Italians? 

A.  There  is  from  .24  to  .36  of  an  inch  difference. 

Q.  How  do  the  New  England  jaws  differ  from 
English? 

A.  The  English  jaw  is  relatively  smaller. 

Q.  How  is  development  harmonizing  the  long 
diameter  of  the  teeth  with  the  size  of  the  jaw? 

A.  By  reducing  the  size  of  teeth  or  causing  their 
disappearance. 

Q.  In  primitive  races  is  the  third  molar  well  devel¬ 
oped? 

A.  It  is.  It  also  has  ample  room. 

Q.  How  is  the  alveolar  process  assisted  in  develop¬ 
ment? 

A.  When  all  the  teeth  are  in  the  jaw,  they  wedge 
the  alveolar  process  outwards,  thus  expanding  it. 

Q.  Is  the  third  molar  larger  or  smaller  in  the 
Orang,  or  Chimpanzee,  than  in  man? 

A.  Larger. 

Q.  How  is  it  in  man? 

A.  The  reverse.  The  first  molar  is  largest,  and 
they  decrease  in  size  from  before,  backwards. 

Q  Is  the  loss  of  teeth  often  in  harmony  with 
arrested  jaw  development? 

A.  It  is  not. 

Q.  What  is  one  of  the  great  causes  of  arrested  jaw 
development? 

A.  Disuse,  which  prevents  blood  from  being  carried 
to  the  parts  for  nourishment. 


82 


QUIZ  COMPEND 


Q.  How  do  the  two  jaws  differ  in  this  respect? 

A.  The  upper  jaw  is  more  frequently  arrested, 
owing  to  the  fact  that  it  is  a  fixed  bone. 

Q.  Under  what  circumstances  are  the  jaws  liable 
to  become  excessively  developed? 

A.  In  neurotics  and  degenerates  the  nervous  sys¬ 
tem  is  unstable,  thus  carrying  more  than  the  usual 
amount  of  nourishment  to  the  parts. 

Q.  Which  jaw  is  the  most  liable  to  become  exces¬ 
sively  developed? 

A.  The  inferior  maxilla,  because  it  is  mobile. 

Q.  When  the  inferior  maxilla  is  developed  in 
excess  of  the  superior,  what  mistake  is  sometimes 
made  by  the  dentist? 

A.  It  is  supposed  that  the  patient  has  “jumped  the 
bite.  ' 

Q.  Are  teeth  more  liable  to  decay  upon  the  upper 
jaw  than  upon  the  lower? 

A.  Y es. 

Q.  Why? 

A.  Because  the  upper  is  degenerating  faster  than 
the  lower. 

Q.  Is  degeneracy  (or  arrest  of  development)  of  the 
jaws  and  teeth  a  cause  of  decay? 

A.  Yes.  It  is  the  principal  cause.  In  the  evolu¬ 
tion  of  tooth  structure,  the  closing  of  the  apical  end 
of  the  root,  the  malformation  of  tooth  structure  cuts 
off  nourishment,  and  with  the  lost  art  of  mastication, 
tends  to  produce  malnutrition. 

y 

Q.  How  do  these  conditions  mentioned  hasten 
decay? 

A.  Defective  enamel  and  low  vitality  allow  lactic 
acid  ferments  an  easy  prey  upon  tooth  structure. 


ON  IRREGULARITIES  OF  THE  TEETH. 


83 


Q.  Do  constitutional  conditions  produce  marked 
effect  upon  the  teeth? 

A.  They  do.  Syphilis,  tuberculosis,  pregnancy, 
Bright’s  disease,  and  all  diseases  with  disturbances  in 
nutrition,  as  well  as  senility,  predispose  to  tooth  decay. 

Q.  If  evolution  of  the  jaws  and  teeth  be  underlying 
cause  of  tooth  decay,  then  do  marked  differences  result 
in  decay  of  individual  teeth? 

A.  Yes.  Because  of  the  fixedness  of  the  upper 
jaw  and  its  proneness  to  degeneracy,  these  teeth  are 
more  susceptible  to  decay,  according  to  Magitot,  in  the 
proportion  of  3.2,  according  to  Hitchcock  1.9,  or  very 
nearly  two  to  one. 

Q.  How  about  the  teeth  on  each  jaw? 

A.  The  molars  are  more  liable  to  decay  than  the 
bicuspids,  the  bicuspids  than  the  cuspids  or  incisors. 
■The  evolution  of  the  jaws  and  the  lost  art  of  mastica¬ 
tion  directly  affect  the  molars  or  grinding  teeth  first. 

Q.  Is  it  true  that  if  a  tooth  remain  in  the  jaw 
before  it  erupt,  the  longer  will  the  individual  have  it, 
and  the  stronger  will  the  tooth  become? 

A.  This  is  but  partially  true.  Thus  degenerate 
conditions  and  loss  of  the  third  molars  are  along  the 
line  of  evolution.  Owing  to  its  degeneration,  its 
vitality  is  reduced,  and  it  almost  always  decays  early. 
Its  power  of  resistance  depends  much  upon  its  shape 
and  number  of  roots,  meaning  blood  supply. 

Q.  Does  the  mechanical  arrangement  in  the  erup¬ 
tion  of  the  teeth  and  the  movement  of  the  jaw  assist 
in  enlargement? 

A.  It  does.  Thus  want  of  mastication,  as  in  idiots, 
may  cause  arrest  of  development  and  irregularities  of 
the  teeth. 


CHAPTER  VII. 


DEVELOPMENT  OF  TIIE  ALVEOLAR  PROCESS. 

Q.  What  is  the  alveolar  process? 

A.  It  is  the  part  of  the  jaw  bone  that  contains  the 
teeth. 

Q.  Where  is  it  located? 

A.  Upon  the  upper  border  of  the  inferior  maxilla 
and  upon  the  lower  border  of  the  superior  maxilla. 

O.  How  does  it  differ  from  the  jaw  bone  proper? 

A.  The  jaws  proper  are  composed  of  dense,  hard 
bone  structure,  which  remain  throughout  life  for  the 
purpose  of  attachment  of  muscles,  while  the  alveolar 
process  is  made  up  of  cancellated  bone  structure, 
which  comes  and  goes  with  the  teeth. 

Q.  When  does  it  first  make  its  appearance? 

A.  When  the  first  teeth  erupt. 

Q.  What  becomes  of  it  when  the  first  teeth  are 
shed? 

A.  It  absorbs  away. 

Q.  When  does  it  reappear? 

A.  When  the  permanent  teeth  erupt. 

Q.  Does  the  process  always  follow  the  teeth? 

A.  Yes.  No  matter  how  irregularly  they  may 
erupt,  the  process  builds  itself  about  the  roots  of 
the  teeth. 

Q.  Do  alveolar  processes  differ  in  length  and 
width? 

A.  Yes.  The  length  of  the  alveolar  process 
depends  upon  the  length  of  the  roots  of  the  teeth,  and 

85 


86 


QUIZ  COMPEND 


the  length  of  the  rami.  The  teeth  continue  to  erupt 
until  they  reach  occlusion.  The  width  also  depends 
upon  the  length  of  the  rami ;  if  short,  the  alveolar 
process  is  short  and  thick. 

Q.  What  causes  some  small  vaults  to  be  high  and 
others  low? 

A.  The  length  of  the  alveolar  process. 

Q.  Is  the  process  between  the  teeth  growing 
thinner? 

A.  It  is.  This  is  due  to  the  change  in  the  shape 
of  the  crowns  of  the  teeth.  Once  they  were  bell¬ 
shaped,  now  they  are  almost  straight,  thus  lessening 
the  width  of  the  septum. 

Q.  Of  what  is  the  alveolar  process  composed? 

A.  The  alveolar  process  is  composed  of  a  fibrous 
mesh,  filled  with  lime  salts,  loosely  put  together. 
When  treated  with  acids,  the  lime  salts  are  destroyed. 
When  treated  with  heat,  the  fibrous  tissue  is  removed. 
In-  both  cases  the  shape  of  the  structure  is  retained. 

Q.  How  are  the  teeth  held  in  position? 

A.  By  a  process  called  gomphosis,  which  resembles 
the  attachment  of  a  nail  in  a  board,  by  their  exact 
adaptation  to  the  tissue.  AVhen  bent  or  irregular,  they 
receive  support  from  all  sides,  and  by  the  peridental 
membrane. 

Q.  Does  absorption  of  the  alveolar  process  occur 
when  the  teeth  are  in  position? 

A.  \  es.  Sensile  absorption,  or  osteomalacia,  may 
occur  at  any  period  after  the  person  has  obtained  his 
growth.  Should  man  live  long  enough,  he  would  lose 
his  second  set  of  teeth  normally. 

Q.  What  becomes  of  the  alveolar  process  after  the 
second  set  of  teeth  are  removed? 


ON  IRREGULARITIES  OF  THE  TEETH. 


87 


A.  The  process  absorbs  entirely  away. 

Q.  When  the  dental  arch  expands,  does  the  alveolar 
process  move? 

A.  Yes,  to  a  certain  extent.  When  teeth  are  reg¬ 
ulated,  the  process  will  move  and  build  about  them  to 
a  limited  extent. 

Q.  Does  the  alveolar  process  vary  in  position? 

A.  Very  materially.  The  eruption  of  the  teeth  is 
purely  mechanical,  depending  upon  the  number  and 
size  of  the  jaw  bone  and  manner  of  eruption.  The 
position  and  shape,  therefore,  depends  entirely  upon 
the  shape  assumed  by  the  teeth. 

O.  Will  the  alveolar  process  develop  if  the  teeth 
are  not  present? 

A.  It  will  not. 

Q.  Is  there  excessive  and  arrested  development  of 
the  alveolar  process? 

A.  It  is  very  common.  Owing  to  the  transitory 
nature  of  this  structure,  it  is  easily  affected  by  nutri¬ 
tion  changes.  A  normal  development  is  noticed  when 
one  or  more  teeth  do  not  antagonize  with  those  on 
the  opposite  jaw.  The  alveolar  process  will  lengthen 
until  they  meet  resistance.  Arrest  of  development 
is  noticed  in  cases  of  rickets,  hydrocephalous,  anaemia, 
syphilis,  tuberculosis,  etc. 

O.  Is  excessive  development  frequently  observed 
in  degenerates? 

A.  Yes.  Owing  to  the  unstable  nature  of  the 
nervous  system,  the  alveolar  process  is  easily 
affected. 

Q.  When  is  hypertrophy  found? 

A.  It  is  very  common  among  neurotics  and  degen¬ 
erates.  It  may  affect  only  one  tooth,  such  as  the  third 


‘88 


QUIZ  COMPEND 


molar,  or  one  side  of  the  mouth,  or  the  entire  alveolar 
process  may  become  involved. 

Q.  How  does  the  alveolar  process  appear  under 
the  microscope? 

A.  Not  unlike  bone.  It  contains  Haversian  canals 
of  two  kinds,  one  with  the  regular  lamella;  system 
surrounding  it,  the  other  the  small  vessels  of  Von 
kbner,  which  have  no  surrounding  lamella;. 

Q.  Describe  them. 

A.  The  Haversian  canals  are  large,  round"  smooth 
spaces,  containing  a  single  artery.  The  dark  spots 
circling  each  are  the  lacuna;.  The  thread-like  spaces 
are  canaliculi,  which  run  from  one  lacuna  to  another 
and  from  one  Haversian  canal  to  a  lacuna.  The 
spaces  between  are  filled  with  lime  salts.  The  vessels 
of  Von  Ebner  are  little  blood  vessels,  running  in  all 
directions  and  penetrating  the  layer  of  bone.  They 
are  for  the  purpose  of  nourishing  the  bone  structure. 


. 


. 


CHAPTER  VIII. 


DEVELOPMENT  OE  THE  VAULT, 

Q.  What  names  has  the  roof  of  the  mouth? 

A.  The  arch,  the  dome,  the  palate,  the  vault. 

Q.  Which  is  the  most  common? 

A.  The  arch. 

Q.  Why  should  this  term  not  be  used?  . 

A.  Because  it  conflicts  with  the  use  of  the  estab¬ 
lished  term,  dental  arch.  When  speaking  of  a  V,  or 
saddle  arch,  the  dental  and  not  the  roof  of  the  mouth 
is  meant. 

Q.  What  are  better  terms? 

A.  The  vault,  or  palate. 

Q.  What  constitutes  the  vault? 

A.  The  vault  is  composed  of  the  hard  and  soft 
palate  and  the  alveolar  process. 

Q.  Of  what  does  the  hard  palate  consist? 

A.  The  hard  palate  consists  of  two  horizontal 
plates  of  bone  extending  from  the  superior  maxillary 
bones  upon  either  side,  and  uniting  at  the  median  line, 
and  from  the  anterior  alveolar  process  in  front,  it 
extends  back  and  unites  with  the  soft  palate. 

Q.  What  bones  constitute  the  vault? 

A.  It  is  composed  of  two  incisive  bones,  two  palate 
plates  of  the  superior  maxilla  and  two  horizontal  plates 
of  the  palate  bones. 

Q.  At  what  period  does  ossification  of  the  median 
suture  occur? 

A.  It  varies  in  different  individuals,  sometimes  as 

89 


'90 


QUIZ  COMPEND 


early  as  the  third  and  fourth  years,  and  in  neurotics 
and  degenerates  as  late  as  the  fifteenth  and  sixteenth 
years. 

Q.  How  can  this  wide  difference  in  years  be  deter¬ 
mined? 

A.  In  widening  the  arch  by  the  jack-screw,  or  other 
means.  It  is  not  uncommon  to  open  the  suture  in 
children  from  fourteen  to  sixteen  years  of  age. 

Q.  Is  this  detrimental  to  the  operation? 

A.  No.  It  is  of  great  advantage.  It  produces 
greater  harmony  in  appearance  with  very  little 
expense  to  the  tissues. 

Q.  What  two  cavities  does  the  vault  separate? 

A.  The  mouth  and  nasal  eavities. 

O.  With  what  structure  is  the  vault  connected? 

A.  The  alveolar  process. 

Q.  What  bones  are  connected  with  the  upper  border 
of  the  vault? 

A.  The  nasal  bones  and  vomer. 

Q.  Describe  the  vomer. 

A.  This  bone  is  situated  (in  its  normal  position)  in 
the  center  of  the  nose,  .extends  from  before,  back¬ 
ward,  the  entire  length  of  the  vault.  It  divides  the 
nasal  cavity  into  two  complete  cavities.  The  bone  is 
thinnest  at  the  median  line.  As  it  extends  downwards 
it  thickens.  When  it  reaches  the  floor  of  the  vault  it 
gracefully  curves  to  the  right  and  left,  making  a  broad 
foundation  for  the  superior  structure  to  rest  upon. 

Q.  Describe  the  surface  of  the  vault. 

A.  The  palatal  surface  is  very  uneven ;  at  the  suture 
is’often  found  a  ridge  of  bone  resembling  a  rope-like 
section,  extending  a  short  distance,  or,  in  some  cases, 
the  entire  length. 


ON  IRREGULARITIES  OF  THE  TEETH. 


91 


Q.  In  what  people  are  these  irregularities  found 
most  frequently  to-day? 

A.  Among  people  whose  nervous  systems  are 
unstable. 

Q.  What  do  they  seem  to  be? 

A.  Exostoses  of  the  bone  along  the  line  of  the 
suture,  due  to.  irritation  in  mastication  before  ossifica¬ 
tion  takes  place. 

O.  Is  there  evidence  of  atavism? 

A.  In  lower  animals,  such  as  the  hare  and  the 
camel,  there  is  a  permanent  slit  in  the  lip.  The 
tendency  to  cleft-palate  is  also  an  atavistic  condition. 
The  ossification  of  this  suture,  therefore,  is  very  un¬ 
stable  in  character.  The  result  is,  therefore,  a  ten¬ 
dency  to  late  ossification,  resulting  in  exostosis. 

Q.  What  covers  the  vault  upon  both  surfaces? 

A.  Both  surfaces  are  covered  by  mucous  mem¬ 
branes.  They  extend  backward  and  form  the  soft 
palate. 

Q.  Does  the  hard  palate  vary  in  thickness? 

A.  Yes.  When  it  unites  with  the  alveolar  process 
it  is  quite  thick,  and  also  at  the  median  line;  while 
about  midway  between,  and  at  the  posterior  surface, 
it  is  as  thin  as  tissue  paper. 

Q.  How  does  the  soft  palate  differ  in  different 
individuals? 

A.  In  a  dolichocephalic  head  the  soft  palate  will 
curve  slowly  backward,  thus  giving  a  long  sweep  from 
before,  backwards.  On  the  other  hand,  in  brachy- 
ccphalic  heads,  the  soft  palate  will  curve  abruptly.  In 
some  cases  the  soft  palate  will  drop  straight  down, 
thus  limiting  the  distance  from  before,  backward,  the 
length  of  the  hard  palate. 


92 


QUIZ  COMPEND 


Q.  Is  the  vault  in  connection  with  the  first  teeth 
ever  deformed? 

A.  Only  very  rarely  and  in  extreme  cases.  Until 
the. sixth  year  the  vault  is  in  most  cases  well  formed. 
The  curves  are  all  graceful  in  outline  and  the  contour 
of  the  dental  arch  is  well  formed.  This  could  hardly  be 
otherwise, for  the  reason  that  the  jaw  is  growing  rapidly 
for  the  purpose  of  containing  the  permanent  teeth. 

Q.  Are  any  two  vaults  just  alike? 

A.  They  are  not.  They  are  neither  alike  in  height, 
width  nor  contour,  although  each  may  be  normal  in* 
itself. 

Q.  How  is  the  vault  held  in  position? 

A.  On  the  sides  by  the  walls  of  the  antrum,  backed 
by  the  malar  process,  and  the  alveolar  process  and 
maxillary  bones. 

Q.  At  what  period  does  the  great  change  take 
place  in  the  shape  of  the  vault? 

A.  Between  the  period  when  all  the  temporary 
teeth  are  in  place  and  all  the  permanent  teeth  have 
erupted. 

Q.  Is  there  not  a  more  definite  time? 

A.  The  vault  generally  makes  its  greatest  change 
after  the  eruption  of  the  first  permanent  molars,  and 
becomes  fixed  at  the  time  of  the  eruption  of  the  second 
permanent  molars. 

Q.  What  change  takes  place? 

A.  Externally  the  rami  is  quite  important.  If  the 
person  is  developing  normally  the  rami  will  grow  in 
harmony  with  other  structures,  and  the  face  will 
elongate.  The  alveolar  process  will  grow  up  and  down 
upon  the  jaws,  carrying  the  teeth  with  it,  until  they 
antagonize.  The  teeth  being  larger  and  the  roots 


ON  IRREGULARITIES  OF  THE  TEETH. 


93 


longer,  the  alveolar  process  lengthens;  this  makes  the 
vault  higher. 

Q.  Does  the  angle  of  the  jaw  change  in  other  direc¬ 
tions? 

A.  From  before,  backwards,  it  grows  from  an 
obtuse  to  a  right  angle. 

Q.  How  can  the  height  of  the  alveolar  process  upon 
the  lower  jaw  be  judged? 

A.  Early  in  life  the  mental  foramen  is  located  upon 
the  upper  border  of  the  jaws.  At  the  middle  life  it  is 
situated  midway,  and  sometimes  two-thirds  below  the 
upper  border. 

Q.  When  the  rami  do  not  develop  in  harmony  with 
the  other  bones  of  the  face,  what  happens? 

A.  In  neurotics  and  degenerates  there  may  be 
arrest  and  excessive  development  of  the  rami,  or  one 
side  may  grow  longer  or  shorter  than  the  other.  In 
such  cases  there  is  a  marked  change  in  the  shape  of 
the  face. 

Q.  What  changes  take  place  in  the  mouth? 

A.  If  the  rami  do  not  develop  when  the  first  and 
second  molars  come  into  place,  the  jaws  are  open  in 
front,  the  molars  only  touching.  When  the  mouth  is 
closed,  the  vault  is  high.  If  the  alveolar  process  does 
not  develop,  the  face  is  very  short,  giving  a  youthful 
appearance  to  an  adult  face.  If  the  rami  are  long,  it 
gives  a  long  appearance  to  the  face,  the  alveolar  pro¬ 
cess  elongates,  and  the  vaults  are  always  high. 

Q.  The  high  vault,  then,  is  not  due  to  its  being 
pushed  or  pulled  up  by  pressure  exerted  through  the 
vomer. 

A.  No,  that  is  a  physical  impossibility;  nor  can 
the  shape  of  the  base  of  the  skull  in  any  way  affect  it. 


94 


QUIZ  COMPEND 


The  height  is  due  entirely  to  the  lengthening  of  the 
alveolar  process. 

Q.  What  difference  is  there  in  the  height  of  vault 
in  children  and  adults? 

A.  In  317  children,  under  five  years  of  age,  it 
measured  .17  lowest,  .62  highest,  with  an  average  of 
.42  inches.  In  4,614  adults,  the  lowest  vault  was  .21, 
the  highest  .84,  with  an  average  of  .58. 

Q.  How  is  this  demonstrated? 

A.  By  an  instrument  made  for  the  purpose.  The 
measurements  are  taken  from  the  gum  margin,  at  the 
neck  of  the  second  temporary  molar,  to  the  center  of 
the  vault;  in  the  permanent  set  at  the  gum  margin, 
between  the^  second  bicuspid  and  first  permanent 
molar,  to  the  center  of  the  vault. 

Q.  In  comparing  the  height  of  vault  of  present  peo¬ 
ples,  and  those  of  ancient  skulls,  how  do  they  differ? 

A.  They  are  a  little  higher  than  the  ancient. 

Q.  Can  any  race,  sect,  or  intellect  claim  a  type 
of  vault? 

A.  They  cannot. 

Q.  What  does  the  width  of  the  vault  depend  upon? 

A.  The  development  of  the  jaw  bone  and  alveolar 
process. 

Q.  After  an  examination  of  thousands  of  skulls, 
having  normal  dental  arches,  and  no  two  alike,  how 
can  a  normal  arch  be  defined? 

A.  A  normal  vault  is  one  where  the  dental  arch  is 
regular,  and  the  different  outlines  possess  graceful 
curves,  regardless  of  height,  width  and  length. 

Q.  Are  narrow  arches  found  among  early  races? 

A.  They  are  not. 

Q.  Where  are  they  found? 


ON  IRREGULARITIES  OF  THE  TEETH. 


95 


A.  Among  modern  neurotic  people. 

Q.  What  is  the  direct  cause  of  narrow  arches? 

A.  A  neurotic,  unstable  brain,  due  to  conditions 
producing  arrested  development  of  the  jaws.  The 
eruption  of  the  teeth  is  purely  mechanical,  wedging 
their  way  into  place  as  best  they  can.  The  arch 
becomes  broken,  and  a  V  or  saddle  arch,  or  some  one 
of  their  modifications,  develops. 

Q.  Does  the  alveolar  process  depend  upon  tooth 
arrangement  for  its  shape? 

A.  It  does,  and  in  this  way  the  vault  becomes 
narrow,  arid  in  a  measure  gets  its  shape.  The  height 
of  vault  is  of  little  importance. 

O.  In  contracted  dental  arches,  may  the  vaults  be 
high  or  low? 

A.  Yes. 

Q.  Is  high  vault  ever  due  to  contracted  jaw? 

A.  It  is  not.  The  vault  appears  to  be  high,  owing 
Ho  the  contraction  of  the  dental  arch  and  the  alveolar 
process. 

Q.  On  what  does  the  width  of  the  vault  depend? 

A.  On  the  development  of  the  maxillary  bones  and 
alveolar  process. 

Q.  How  must  vaults  be  classified? 

A.  By  taking  a  large  number  of  measurements  and 
obtaining  an  average. 

Q.  What  was  the  result? 

A.  The  highest  was  i.,  the  lowest  .25,  with  an 
average  of  .  55. 

Q.  What  would  be  the  average  width  of  vault? 

A.  By  measuring  a  large  number  of  jaws  between 
the  second  bicuspid  and  first  permanent  molar;  maxi¬ 
mum,  1.87;  minimum,  .75,  with  an  average  of  1.19. 


CHAPTER  IX. 


DEVELOPMENT  OF  THE  PERIDENTAL  MEMBRANE. 

Q.  What  is  the  peridental  membrane? 

A.  It  is  a  fibrous  tissue  covering  the  roots  of  the 
teeth  and  lining  the  inner  walls  of  the  alveolus. 

Q.  From  what  layer  is  it  derived? 

A.  From  the  mesoblastic  layer. 

Q.  How  does  it  differ  from  the  periosteum? 

A.  There  is  very  little  difference  between  them ; 
both  come  from  the  mesoblastic  layer. 

Q.  Of  what  does  the  peridental  membrane  consist? 

A.  It  consists  of  four  kinds  of  fibers:  an  outer 
layer  of  coarse,  white,  fibrous  tissue,  an  inner  layer  of 
fine,  white  fibrous  tissue,  elastic  fibers,  and  pene¬ 
trating  fibers  (fibers  of  Sharpey). 

Q.  How  do  the  fibers  of  the  periosteum  differ  from 
those  of  the  peridental  membrane? 

A.  Those  of  the  periosteum  are  coarse,  and  run 
parallel  with  the  alveolar  process  over  the  border  and 
extend  as  far  as  the  union  of  the  epithelial  layer  and 
the  periosteum.  [The  Dental  Ligament.  Black.] 

Q.  Where  do  the  fine  fibers  extend? 

A.  They  extend  in  all  directions,  and  enter  the 
alveolar  process  at  every  point. 

Q.  How  do  they  look  under  the  microscope? 

A.  If  a  section  of  the  alveolar  process  be  treated 
with  acids,  or  a  section  affected  with  osteomalacia  be 
placed  under  the  microscope,  the  fibers  will  be  seen  to 
retain  the  original  shape  of  the  bone. 

97 


98 


QUIZ  COMPEND 


Q.  Are  the  fibers  continuous  throughout  the  peri¬ 
dental  membrane,  alveolar  process  and  periosteum? 

A.  They  are. 

Q.  Has  the  periosteum  a  blood  supply? 

A.  It  is  very  rich  in  blood  vessels.  They  anasto¬ 
mose  with  each  other  and  enter  the  alveolar  process  in 
all  directions  through  the  Haversian  canals  and 
vessels  of  Von  Ebner. 

Q.  Are  they  more  numerous  in  this  locality  than 
in  connection  with  other  bones? 

A.  Owing  to  the  transitory  nature  of  the  peridental 
membrane  and  alveolar  process,  they  are. 

Q.  What  function  has  the  peridental  membrane? 

A.  It  fills  the  space  between  the  root  of  the  tooth 
and  the  alveolar  process,  being  a  cushion  for  the  teeth 
to  rest  upon.  It  is  present  when  the  teeth  are  present 
to  furnish  nourishment.  It  holds  the  teeth  in  their 
sockets. 

Q.  What  other  functions  have  the  fibers  of  the 
peridental  membrane? 

A.  It  is  a  mesh  which  holds  the  lime  salts  in  posi¬ 
tion. 

Q. .  Where  does  calcification  commence? 

A.  At  the  center  of  the  jaw.  It  gradually  fills  in 
until  the  fibers  of  peridental  membrane  become  very 
thin,  and  in  old  age  it  is  almost  entirely  lost. 

Q.  What  are  the  “fibers  of  Sharpey?” 

A.  They  are  fibers  of  connective  tissue  that  pene¬ 
trate  radially  from  the  peridental  membrane,  or  per¬ 
iosteum,  or  outer  lamellae  of  bone  into  the  deeper 
layer. 

Q.  How  are  the  fibers  of  Sharpey  arranged? 

A.  The  fibers  extend  in  all  directions,  but  do  not 


ON  IRREGULARITIES  OF  THE  TEETH. 


99 


enter,  as  claimed  by  Gray,  like  so  many  tacks  driven 
into  a  board,  uniformly  and  regularly.  In  some  local¬ 
ities  they  penetrate  in  large  quantities,  and  almost 
surround  a  piece  of  bone;  again,  a  few  fibers  pene¬ 
trate  only  a  short  distance.  In  other  places  they  can 
be  traced  a  long  distance. 

Q.  How  do  these  fibers  compare  with  those  in  lower 
animals? 

A.  They  are  much  finer  in  man. 

Q.  Are  the  fibers  elastic? 

A.  They  are.  A  tooth  can  be  turned  half  way 
around  by  stretching  the  fibers,  without  breaking. 

Q.  When  are  the  fibers  most  elastic? 

A.  In  youth,  becoming  less  so  as  age  advances, 
when  the  membrane  grows  thinner,  and  almost  a  bony 
union  has  taken  place. 

Q.  When  inflammation  sets  in,  what  becomes  of 
the  earthy  substance? 

*  A.  When  inflammation  sets  in  as  a  result  of  death 
of  pulp  or  from  auto-intoxication,  it  becomes  inter¬ 
stitial  in  character,  and  the  lime  salts  are  absorbed. 
Nothing  is  left  but  fibrous  tissue.  This  holds  the  tooth 
in  place,  although  it  moves  backward  and  forward. 

Q.  Do  blood  vessels  exist  in  the  alveolar  process? 

A.  Yes.  Some  run  in  straight  from  the  peridental 
membrane  and  periosteum,  others  run  diagonally, 
others  lengthwise.  They  run  in  all  directions,  close 
to  the  bone  rather  than  near  the  root  of  the  tooth. 

Q.  Why?  ♦ 

A.  There  are  no  arteries  normally  penetrating  the 
sides  of  the  root;  nourishment  is  not  required  at  that 
part  of  the  membrane. 

Q.  How  may  these  blood  vessels  be  seen? 


100 


QUIZ  COMPEND 


A.  By  injecting  the  carotid  artery  of  a  dog,  and 
placing  a  section  of  alveolar  process  under  the  micro¬ 
scope. 

Q.  Are  the  alveolar  process  and  surrounding  tis¬ 
sues  rich  in  vascular  supply? 

A.  Yes.  Especially  in  the  young,  owing  to  the 
transitory  nature  of  the  structure. 


i 


. 


i 


\ 


CHAPTER  X. 


i 


DEVELOPMENT  OF  THE  TEETH. 

O.  What  were  the  teeth  at  their  origin? 

A.  They  were  primitive  organs  of  the  skin.  Accord¬ 
ing  to  Minot  they  were  placoid  scales,  which  were 
dermal  teeth  of  the  shark. 

Q.  What  became  of  the  scales  in  the  advance  of 
evolution? 

A.  They  became  cartilaginous  in  the  human 
embryo  and  assisted  in  development  of  the  skull 
bones. 

Q.  What  became  of  them  later? 

A.  They  dipped  into  the  epidermis,  and  calcifying, 
formed  the  enamel  of  the  tooth,  which  fitted  around 
a  soft  core  or  pulp.  The  tooth  departs  from  the  prim¬ 
itive  method  of  development  since  it  does  not  arise 
from  the  surface,  but  deep  down  in  the  tissue. 

Q.  Flow  is  the  tooth  formed? 

A.  The  structure  grows  down  into  dermis,  forming 
an  oblique  shelf,  which  is  a  special  tooth-forming 
organ.  On  the  under  side  of  the  shelf  the  teeth  are 
developed  the  same  way  as  over  the  skin,  although 
they  are  very  much  larger. 

Q.  Do  the  teeth  develop  as  in  man? 

A.  They  do  not.  They  are  in  various  stages  of 
development,  and  only  one  is  fully  exposed  at  a  time. 
When  one  tooth  has  exceeded  its  usefulness,  it  falls 
out  and  another  tooth  takes  its  place.  Thus  they 
continue  to  develop  indefinitely. 

101 


102 


QUIZ  COMPEND 


O.  What  is  this  condition  called? 

'-w 

A.  It  is  called  polyphyodontia. 

Q.  How  many  sets  of  teeth  have  mammals,  as  a 
rule? 

A.  Two  sets.  The  condition  is  called  diphyodontia. 

Q.  How  are  the  teeth  united  in  the  shark? 

A.  By  a  small  plate  of  dermal  bone  at  the  base. 

Q.  How  do  the  teeth  develop  in  mammals,  as  a 
rule? 

A.  By  a  modification  of  the  jaws,  the  epidermis 
dips  down  into  the  dermis,  and  the  enamel  is  devel¬ 
oped.  The  first  indication  is  a  thickening  of  the 
mucous  membrane  at  the  sixth  week  of  embryonic 
life.  This  ridge  dips  downward  from  the  epithelial 
cord.  This  expands,  forming  the  dental  shelf.  The 
papilla,  comprised  of  blood  vessels  and  fibrous  tissue, 
develops  beneath,  taking  the  shape  of  the  tooth  that 
is  to  form.  The  dental  shelf  farms  around  the 
papillae  and  forms  the  enamel. 

Q.  Where  are  the  dental  sacs  located? 

A  At  the  inner  border  of  the  jaw.  This  gives 
room  for  the  germs  of  the  second  set  to  develop  at  the 
outer  border. 

Q.  Where  are  the  enamel  organs  for  the  last 
molars  obtained? 

A.  The  dental  shelf  is  prolonged  from  the  last 
teeth  without  retaining  the  direct  connection  with  the 
epithelium. 

Q.  In  the  order  of  evolution,  how  do  the  teeth 
evolve? 

A.  The  mammal  teeth  pass  in  evolution  from  the 
simple  types  of  the  oviparous  edentates  to  those  of  the 
indeciduous  ancestors  of  the  sloths  and  armadilloes 


ON  IRREGULARITIES  OF  THE  TEETH. 


103 


and  their  descendants,  including  the  dolphin  and 
whales,  whose  teeth  (in  the  foetal  Greenland  whale 
and  adult  sperm)  preserve  the  old  type.  In  the 
edentates  these  teeth  may  be  few;  in  insectivorous 
mammals,  approximating  those  of  the  reptilian  in 
number,  sixty  or  seventy  on  a  side. 

Q.  How  are  the  human  teeth  evolved  from  the 
primitive  cone  tooth? 

A.  They  are  evolved  by  both  concrescence  and 
differentiation. 

Q.  Has  the  tooth  received  much  attention  from 
anthropologists  and  ethnologists? 

A.  It  has  not.  Flower  has  constructed  a  dental 
index  by  multiplying  the  dental  length  by  ioo,  and 
dividing  by  the  basio-nasal  length. 

Q.  What  are  his  results? 

A.  Caucasic  races  are  microdont  (with  small  teeth 
and  small  dental  index) ;  the  Mongolic  races  mesodont 
(middle  teeth  and  index) ;  the  Negroid  races  are 
megadont  (great  teeth  and  index).  The  anthropoid 
apes  have  still  larger  teeth  and  indices. 

Q.  After  the  teeth  are  formed,  what  becomes  of  the 
rudiments  of  the  enamel  organ? 

A.  These  remain  in  the  deeper  structures.  When 
the  teeth  push  their  way  through  the  gum,  these 
epithelial  cells  are  pushed  to  one  side,  and  they  remain 
encased  in  the  peridental  membrane. 

Q.  What  has  lately  been  claimed  in  regard  to  these 
epithelial  cells? 

A.  It  has  been  alleged  that  they  are  glands. 

Q.  What  theory  was  advanced  by  Kollman  and 
Gegenbauer? 

A.  That  they  are  abortive  rudimentary  survivals 


104 


QUIZ  COMPEND 


from  an  ancestral  condition  in  which  the  teeth  are 
numerous,  as  observed  in  the  shark. 

Q.  What  theory  did  Robin  and  Magitot  advance? 

A.  They  claimed  that  they  were  epithelial  debris, 
a  view  perfectly  compatible  with  that  of  Gegenbauer 
and  Kollman. 

Q.  AVhat  other  views  have  been  advanced? 

A.  The  other  views  corroborate  those  of  Robin  and 
Magitot,  since  epithelial  cells  may  be  found  imbedded 
in  the  derma  in  all  parts  of  the  body.  . 


f 


. 


c 


1 


CHAPTER  XL 


SOCIAL  CONSANGUINITY,  NEAR-KIN,  EARLY  AND 

LATE  MARRIAGE. 

Q.  Has  the  influence  of  intermarriage  in  families 
been  overestimated  as  a  factor  in  producing  defect? 

A.  From  the  general  principles  of  heredity,  already 
laid  down,  it  must  be  obvious  that  the  influence  of 
inter-marriage  in  families  has  been  overestimated  as 
a  factor,  per  se,  in  the  production  of  defect. 

Q.  Is  there  an  advantage  in  cross-breeding? 

A.  The  idea  of  the  advantage  of  cross-breeding, 
which  seemingly  appeared  in  the  practice  of  exogamy 
(marriage  outside  the  tribe,  or  more  often  outside 
those  having  the  same  totem  or  coat-of-arms)  arose 
from  observation  of  deformities  following  intermar¬ 
riages  contracted  after  the  killing  of  girls  for  econ¬ 
omic  reasons  had  led  to  exogamy. 

Q.  What  was  the  origin  of  incest? 

A.  It  was  of  religious  origin  rather  than  innate, 
since  the  totemic  relationship  (which  was  chiefly  pro¬ 
hibited)  was  often  far  from  being  consanguinous. 

Q.  What  was  the  totem? 

A.  It  was  a  mark  indicating  descent  from  a  sup¬ 
posed  animal  ancestor  endowed  with  occult  powers. 

Q.  Could  the  children  with  the  Bear  totem  of  .one 
tribe  marry  those  having  the  same  totem  in  another 
tribe? 

A.  No. 

Q.  What  notions  sprang  from  this  practice? 

105 


106 


QUIZ  COMPEND 


A.  The  medical,  theologic  and  legal  notions  anent; 
the  danger  from  marriage  of  consanguinity,  which 
was  insisted  upon  from  time  to  time  by  medical 
writers,  has  been  recognized  by  ecclesiastic  authority, 
civil  law  and  by  popular  feeling. 

Q.  Has  the  marriage  of  near  relations  been  for¬ 
bidden? 

A.  By  ecclesiastic  and  civil  law,  marriage  of  those 
very  nearly  related  has  been  forbidden  on  other 
grounds  than  that  of  alleged  danger  to  offspring. 

Q.  Does  the  justice  of  such  laws  receive  support? 

A.  vSuch  laws  receive  support  from  medical  obser¬ 
vations,  which  tend  to  show  that  intermarriage  may 
produce  degeneracy,  idiocy  and  insanity. 

O.  Has  this  evidence  been  analyzed? 

A.  \  es.  There  is  more  than  one  explanation  of 
the  facts. 

Q.  Where  lies  the  chief  danger  in  intermarriage? 

A.  With  a  perfectly  healthy  stock,  as  every  breeder 
of  animals  knows,  “in-and-in”  breeding  may  be  prac¬ 
ticed  with  impunity,  but  where  the  stock  is  tainted 
with  disease  or  imperfection,  safety  is  only  to  be  found 
in  “crossing.  ” 

Q.  What  was  the  error  of  the  old  doctrine? 

A.  The  error  of  the  old  doctrine  upon  which  was 
founded  the  prohibition  of  consanguinous  unions  lay, 
not  in  asserting  that  disease  and  deformity  were  more 
often  met  with  in  children  of  these  than  those  of 
other  unions,  for  such  is  the  fact,  but  in  attributing 
these  unhappy  results  merely  to  parental  blood  kin¬ 
dred. 

Q.  Is  there  a  physiologic  reason  why  these  mar¬ 
riages  should  not  take  place? 


ON  IRREGULARITIES  OF  THE  TEETH. 


107 


A.  Over  and  above  the  fact  that  these  consangninous 
marriages  are  almost  certain  to  transmit,  in  an  accen¬ 
tuated  form,  defect  or  tendency  to  disease,  already 
present  in  the  family,  there  is  no  physiologic  reason 
why  such  marriages  should  not  take  place. 

Q.  Can  prize  stock  in-and-in  breeding  be  beneficial? 

A.  Breeders  of  prize  stock  frequently  breed  in-and- 
in,  not  only  with  impunity,  but  with  marked  benefit. 

Q.  Does  this  prove  that  degeneracy  found  in 
children  of  consangninous  marriages  does  not  result 
from  this? 

A.  But  this  fact,  while  going  to  prove  that  it  is 
not  the  mere  blood  relationship  of  the  parents  which 
induces  the  degeneration  so  often  found  in  the  children 
of  consanguinous  marriages,  can  but  rarely  be 
advanced  as  an  argument  in  support  of  the  marriage 
of  blood  relations. 

Q.  How  does  the  stock  raiser  propagate  the  same 
kind? 

A.  The  stock  raiser  only  permits  the  more  perfect 
members  of  his  flock  and  herds  to  continue  their  kind; 
for  this  reason  “in-and-in”  breeding  is  innocuous, 
just  as  it  would  be  in  the  human  family  under  like 
conditions. 

Q.  Do  acquired  characters  disappear  with  inter¬ 
marriage? 

A.  Recently  acquired  characters,  whether  physio¬ 
logic  or  pathologic,  are  very  liable  to  disappear  when 
the  individual  having  such  characters  intermarries  with 
another  not  having  the  same  character. 

Q.  What  is  the  natural  tendency  of  the  offspring? 

A.  In  all  such  cases,  to  revert  to  the  nqrmal  type, 
so  that  unless  the  new  character  be  very  deeply 

9 


QUIZ  COMPEND 


108 

y 

impressed  upon  the  parental  organism,  it  is  almost 
certain  it  will  not  appear  in  the  offspring  of  the  other 
parent  having  nothing  of  the  character. 

Q.  Is  the  character  often  repeated  in  an  accen¬ 
tuated  form  in  the  offspring? 

A.  When  both  parents  are  possessed  of  the  charac¬ 
ter,  whether  it  be  physiologic  or  pathologic,  this 
natural  tendency  to  revert  to  the  original  is  often 
overborne,  and  the  character  is  repeated  in  an  accen¬ 
tuated  form  in  the  offspring. 

Q.  What  happens  in  the  case  of  consanguinous 
marriages? 

A.  This  accentuation  of  family  character  always 
takes  place. 

Q.  Will  taint  be  inherited? 

A.  Each  member  will  inherit  more  or  less  of  it 
from  the  common  ancestor. 

Q.  Cite  the  case  of  cousins. 

A.  The  descendants  of  a  common  grandparent, 
insane  and  of  insane  stock,  are  certain  to  have 
inherited  more  or  less  of  the  insane  diathesis.  Even 
if  the  taint  have  been  largely  diluted  in  their  case 
by  the  wise  or  more  likely  fortunate  marriages  of 
their  blood  related  parents,  yet,  still  they  have 
inherited  a  certain  •  tendency  to  nervous  disease,  and 
if  they  marry  they  must  not  be  surprised  if  that 
taint  appear  in  aggravated  form  in  their  children. 

Q.  Can  parents  always ,  account  for  the  imper¬ 
fections? 

A.  The  blood  kindred  parents  of  idiotic,  epileptic, 
dumb  or  lymphatic  children  often  marvel  when#e 
come  these  imperfections. 


ON  IRREGULARITIES  OF  THE  TEETH. 


109 


Q.  Is  there  always  evidence  to  show  that  tendency 
to  disease  may  be  inherited? 

A.  In  some  cases  the  parents,  and  possibly  the 
grandparents,  of  the  unfortunate  children  have  not 
displayed  any  obvious  evidence  of  the  tendency  to 
disease,  which  they  have  inherited  and  handed  on  to 
their  descendants. 

Q.  Will  parents  deny  the  inheritance  of  certain 
diseases? 

A.  Yes.  Not  looking'  farther  back,  parents  assert 
that  insanity,  epilepsy,  scrofula,  etc.,  are  unknown  to 
their  family.  They  have  never  been  so  afflicted;  why 
should  their  children?  In  like  manner  children  may 
be  epileptic,  blind,  deaf  mute,  lymphatic,  cancerous, 
criminal,  drunkards  or  deformed  from  direct  inherit¬ 
ance,  and  yet  the  family  line  be  honestly  declared 
healthy  in  these  particulars. 

Q.  Is  the  truth  of  Sir  William  Aitken’s  maxim 
obvious? 

A.  Yes.  A  family  history,  including  less  than 
three  generations,  is  useless,  and  may  even  be  mis¬ 
leading. 

Q.  Is  social  consanguinity  a  potent  factor  in  here¬ 
ditary  degeneration? 

A.  Similarity  of  temperament,  induced  by  a  com¬ 
mon  environment,  called  “social  consanguinity,”  is  a 
potent  factor  in  the  production  of  all  hereditary  degen¬ 
eration. 

Q.  Will  similar  customs,  habits,  surroundings,  etc., 
produce  like  diseases? 

A.  Yes.  They  tend  to  engender  like  diseases  and 
degenerations,  irrespective  of  any  blood  relation¬ 
ship. 


110 


QUIZ  COMPEND 


Q.  Do  socially  consangriinous  people,  not  even  dis¬ 
tantly  related,  often  resembled  each  other? 

A.  Yes.  They  are  in  reality  much  more  nearly 
related  in  temperament  than  cousins,  or  even  nearer 
blood  relations  who  have  experienced  widely  different 
modes  of  life. 

Q.  What  is  social  consanguinity? 

A.  The  curse  that  dogs  every  exclusive  tribe  and 
class  and  hurries  them  to  extinction.  It  is  the  chief 
factor  in  the  production  of  the  disease  and  degener¬ 
ations  which  have  stamped  themselves  upon  royal 
families. 

Q.  Is  this  condition  found  in  neurotic  marriages? 

A.  This  social  consanguinity  appears  likewise  in  the 
tendency  of  the  neurotic  to  intermarry,  popularly 
expressed  in  the  proverb  that  “like  clings  to  like.’' 
The  marital  tendency  from  this  likeness  in  mental 
characteristics  has  been  shown  to  be  present,  by  recent 
medical  writers,  so  far  as  Germany,  France,  and  the 
United  States  are  concerned. 

Q.  What  is  the  statistical  evidence? 

A.  There  are  in  Illinois,  according  to  the  most 
recent  estimates,  in  round  numbers,  about  6,000 
insane,  or  one  to  a  little  over  500  of  the  population. 
Even  if  we  double,  treble,  or  quadruple  this  fre¬ 
quency,  to  include  all  that  have  been,  or  are  to  be 
insane,  as  well  as  those  insane  at  the  present  time,  it 
would  not  appear  that  there  was  much  probability  of 
two  insane  persons  being  married,  according  to  any 
ordinary  law  of  chances.  In  fact,  we  find  four  out  of 
104  with  insane  heredity  where  both  father  and  mother 
were  insane.  In  one  of  these  cases  the  insane  heredity 
involved  both  parents  and  grandparents  on  each  side, 


ON  IRREGULARITIES  OF  THE  TEETH. 


Ill 


though  in  the  case  of  the  latter  the  histories  show  it 
only  as  collateral.  Besides  these  three  patients,  two 
had  direct  maternal  and  collateral  paternal  hered¬ 
ity,  and  in  one  case  there  was  collateral  heredity 
of  insanity  on  both  sides.  This  makes  altogether 
nearly  ten  per  cent,  of  those  with  insane  heredity  with 
it  on  both  sides,  maternal  and  paternal,  and  thus 
favored  with  a  double  opportunity  to  inherit  mental 
disease.  If  to  this  be  added  the  instances  where,  with 
insanity  of  one  parent  there  is  either  epilepsy,  hysteria, 
or  drunkenness,  brain  disease,  nervousness,  etc.,  of 
the  other,  the  ratio  of  double  inheritance  rises  to 
over  twenty  per  cent. 

Q.  Is  much  taint  required  to  cause  degeneration  of 
the  face,  jaws,  and  irregularities  of  the  teeth? 

A.  Since  the  jaws  and  face  are  transitory  struct¬ 
ures,  relatively  little  taint  is  needed  in  a  family  or 
community  to  cause  degeneration  of  the  face  and 
jaws,  and  irregularities  of  the  teeth. 

Q.  Is  this  factor  overestimated  in  deformities  of 
neurotics? 

A.  The  influence  of  these  neurotic  and  social  con¬ 
sanguinity  tendencies  in  the  production  of  deformities 
of  the  face  and  jaws  and  irregularities  of  the  teeth 
cannot  well  be  overestimated. 

O.  Cite  a  test  of  these  influences. 

A.  A  test  of  these  influences  is  alleged  to  exist  in 
the  Polynesian  population  of  the  Pacific  Islands,  where 
race  admixture  can  be  excluded  for  a  relatively  long 
period.  It  was  claimed  that  here  was  a  people  isolated 
from  all  others  for  at  least  1,400  years,  with  no  admix¬ 
ture  of  races,  yet  irregularity  of  the  teeth  of  both  max- 


112 


QUIZ  COMPEND 


illae  was  almost  as  common  as  it  is  among  the  mixed 
races  of  to-day. 

Q.  What  is  to  be  peculiarly  reckoned  with  the 
Polynesians? 

A.  Excessive  licentiousness  shown  in  societies  for 
the  practice  of  extreme  sexual  indulgence  like  the  Areoi. 

Q.  What  do  these  societies  create? 

A.  They  create  neurotic  states  and  tendencies,  and 
produce  more  marked  degeneracy  of  the  face,  jaws 
and  teeth  than  intermixture  of  race  or  consanguinous 
marriage. 

Q.  Can  the  factors  of  race  admixture  be  excluded 
from  the  ancient  Hawaiians? 

A.  As  the  Polynesians  and  Malays  are  great  navi¬ 
gators,  it  cannot  be  completely  excluded  from  consid¬ 
eration. 

Q.  Will  leprosy,  like  syphilis,  check  development 
without  causing  infection  in  utero? 

A.  This  factor  has  likewise  to  be  taken  into  consid¬ 
eration. 

Q.  Has  the  mortality  among  Hawaiian  babies  been 
large? 

A.  Yes. 

Q.  What  are  the  conditions  as  to  hygiene? 

A.  Hygiene  is  practically  unknown. 

Q.  What  is  the  medicinal  agent  of  the  Kahuna 
(sorcerer-medicine  man)  ? 

A.  An  intoxicant,  kava-kava  (the  fermented  juice 
of  the  awa). 

Q.  Is  syphilis  common? 

A.  Yes.  Especially  the  non-venereal  type. 

Q.  Do  the  habits  of  the  natives  aid  the  spread  of 
the  disease? 


ON  IRREGULARITIES  OF  THE  TEETH. 


113 


A.  Yes. 

Q.  What  is  the  result? 

A.  Under  such  conditions,  irregularities  are  fre¬ 
quent. 

Q.  Is  the  age  of  the  mother  at  pregnancy  ignored 
in  dealing  with  defects? 

A.  Yes.  It  was  pointed  out  two  decades  ago  that 
the  offspring  of  early  and  senile  marriages  were 
defective  and  multiple,  and  too  nearly  repeated  preg¬ 
nancies  were  of  frequent  occurrence. 

Q.  What  often  determines  degeneracy? 

A.  In  all  degenerate  forms,  age  of  the  parent 
must  be  taken  into  consideration. 

Q.  What  investigations  have  been  made  as  to  the 
age  of  parent  upon  degeneracy? 

A.  The  age  of  mothers  of  degenerates  is  often 
below  twenty-five  years.  In  an  investigation  of  the 
influence  of  the  age  of  parents  on  the  vitality  of 
children,  found  that  the  proportion  of  deaths  among 
children  from  unhealthy  constitutions  or  maladies  * 
traceable  to  the  mother  was  twice  as  large  among  the 
children  of  mothers  under  twenty  as  among  the 
children  of  mothers  over  thirty.  The  healthiest  off¬ 
spring  are  born  of  mothers  between  twenty  and  thirty, 
united  to  husbands  between  thirty  and  forty.  Where 
either  husband  or  wife  was  under  twenty,  the  offspring 
usually  proved  weakly.  This  is  particularly  the  case 
even  in  Hungary,  where  the  girls  become  women  at 
thirteen.  In  that  country,  in  twenty-five  per  cent,  of 
the  number  of  marriages,  the  brides  are  under  twenty 
years  of  age. 

Q.  What  has  been  found  in  regard  to  criminals? 

A.  Among  all  classes  of  criminals  there  is  an 


114 


QUIZ  COMPEND 


excess  of  immature  parents  (under  twenty-five)  or 
senile  parents  (over  forty-two). 

Q.  What  is  a  well-known  fact? 

A.  It  is  a  well-known  fact  that  children  of  the  aged 
exhibit  degeneracy. 

Q.  Does  premature  and  late  marriage  have  an 
influence  in  the  production  of  idiocy? 

A.  They  have  been  recognized  as  having  great 
influence. 

Q.  At  what  stage  may  arrest  of  foetal  development 
take  place  in  idiocy? 

A.  Factors  capable  of  the  production  of  idiocy  may 
arrest  foetal  development  at  all  stages. 

Q.  Cite  a  case. 

A.  In  a  Nova  Scotian  family,  of  Scotch  extrac¬ 
tion,  the  mother  still  continued  to  bear  children  until 
she  was  sixty-three  years  old.  There  had  been  no 
pregnancy  between  fifty  and  fifty-six.  At  fifty-six  a 
son  was  born,  who  had  ear,  jaw  and  skull  stigmata, 
and  became  a  periodical  lunatic  at  twenty-five.  A 
son,  born  a  year  later,  was  a  six-fingered  idiot,  with 
retinitis  pigmentosa.  Three  of  the  next  children 
were  paralytic  idiots  in  infancy.  One  of  the  next 
children  was  a  periodical  sexual  invert  female.  The 
last  child  was  an  epileptic.  The  children  born  before 
the  age  of  fifty  were  normal  and  averaged  sixty  years 
of  age, 


CHAPTER  XII. 


ENVIRONMENT,  CLIMATE,  SOIL  AND  FOOD. 

Q.  Was  the  influence  of  climate,  soil  and  food,  and 
other  factors  early  observed? 

A.  Yes. 

Q.  What  seeming  modifications  have  been  pro¬ 
duced? 

A.  Even  skeptical  biologists  admit  that  “the  possi¬ 
bility  is  not  to  be  rejected  that  influences  continued 
for  a  long  time  (that  is  for  generations  and  genera¬ 
tions,  such  as  temperature,  climate,  kind  of  nourish¬ 
ment,  etc.),  which  may  affect  the  germ  plasm  as  well 
as  any  other  part  of  the  organism  may  produce  a 
change  in  the  constitution  of  the  germ  plasm.  But 
such  influences  would  not  then  produce  individual 
variations,  but  would  necessarily  modify  in  the  same 
way,  all  the  individuals  of  a  species  living  in  a  certain 
district.  It  is  possible,  though  it  cannot  be  proved, 
that  many  climatic  varieties  have  arisen  in  this  man¬ 
ner.  Possibly  other  phenomena  of  variations  must  be 
referred  to  a  variation  in  the  structure  of  the  germ 
plasm  produced  directly  by  external  influences.” 

Q.  Upon  what  does  climate  depend? 

A.  The  influence  of  climate  depends  upon  more 
than  the  mere  range  of  temperature  and  meteorologic 
elements. 

Q.  What  does  transferral  from  a  sub-temperate  to 
a  sub- tropic  clime  mean? 

A.  It  means  not  merely  a  change  in  the  necessity 


115 


116 


QUIZ  COMPEND 


for  adaptation  to  temperature  alterations,  but  also 
change  in  the  ease  with  which  food  is  secured  and  the 
stress  of  struggle  for  existence  to  which  man  has  been 
exposed, 

Q.  What  has  soil  and  climate  produced  on  one 
people? 

A.  The  Wurtemburgers  settled  thirty- two  years 
ago  near  Tiflis,  Russian  Georgia.  They  originally  had 

fair  or  red  hair,  light  or  blue  eyes,  and  coarse,  broad 
features.  In  the  first  generation,  brown  hair  and 
black  eyes  became  the  rule,  while  the  face  acquired  a 
noble,  oval  form. 

Q.  Were  these  changes  due  entirely  to  surround¬ 
ings? 

A.  Yes.  There  is  no  record  of  intermarriage  with 
the  Georgians. 

Q.  Did  the  Wurtemburgers  continue  to  speak 
German? 

A.  Yes. 

Q.  Who  were  the  Wurtemburgers? 

A.  A  mixed  race,  in  whom  the  surroundings  in 
Wurtemburg  tended  to  develop  one  type,  while  those 
in  Georgia  developed  another. 

Q.  Were  there  changes  in  the  face,  jaws  and  teeth? 

A.  Yes.  These  changes  in  type  became  clearly 
evident. 

Q.  What  was  the  original  Wurtemburger  type? 

A.  Arrested  facial  development  and  prognathism, 
which  disappeared  under  the  favorable  conditions  of 
Russian  Georgia. 

Q.  What  similar  changes  is  alleged  elsewhere? 

A.  The  alleged  transformation  of  the  Britisher  into 
the  Yankee,  charged  to  the  effects  of  climate  and  soil. 


ON  IRREGULARITIES  OF  THE  TEETH. 


117 


0.  What  is  this  alleged  change? 

A.  The  Yankee  presents  features  of  Indian  type. 
The  glandular  system  is  reduced  to  the  minimum  of 
its  normal  development.  The  skin  becomes  like 
leather.  The  cheeks  are  sallow,  the  head  smaller, 
rounder,  and  covered  with  stiff,  dark  hair.  The  neck 
is  longer.  The  cheek  bones  and  masseters  are  more 
developed.  The  temporal  fossae  become  deeper,  the 
jawbones  more  massive,  the  eyes  lie  in  deep  approxi¬ 
mated  sockets.  The  iris  is  dark,  the  glance  is  piercing 
and  wild.  The  long  bones,  especially  in  the  superior 
extremities,  are  lengthened,  so  that  the  gloves  manu¬ 
factured  in  England  and  France  for  the  American 
market  are  of  a  peculiar  make,  with  long  fingers. 
The  male  pelvis  approaches  that  of  the  female. 

Q.  Has  America  thus  produced  a  new  white  race? 

A.  According  to  Quartrefages,  Pruner  Bey,  and 
others,  this  production  of  the  Yankee  from  the  English 
might  be  called  a  new  white  race. 

Q.  Is  this  hypothesis  correct? 

A.  No.  The  reverse  is  true. 

Q.  Does  this  admit  demonstration? 

A.  Yes.  The  following  instance  is  one  of  many 
that  could  be  mentioned.  In  a  New  England  family, 
with  a  Scandinavian  patronymic,  the  first  generation 
(born  in  1761)  is  represented  by  a  dolichocephalic 
head, with  massive  jaws  and  lips  (especially  the  upper) 
prominent.  The  nose  is  long.  The  eyes  are  set  close 
together.  The  forehead  is  very  high  and  straight. 
In  the  second  generation  the  face  is  not  so  long.  The 
lateral  diameter  is  larger.  The  forehead  is  more 
prominent.  The  eyes  are  a  little  farther  apart.  The 
nose  is  about  the  same  length.  While  there  is  a  gen- 


118 


QUIZ  COM  PEND 


eral  resemblance  about  the  mouth  and  chin,  the  dis¬ 
tance  from  the  front  of  the  chin  to  the  tip  of  the  nose 
is  not  quite  as  long.  In  this  the  shortening  of  the  chin 
has  played  apparently  the  chief  part.  In  the  third 
generation,  the  forehead  is  broader  and  less  retreating 
than  in  the  second.  There  is  less  prognathism  and 
less  prominence  in  the  supra-orbital  region.  In  the 
fourth  generation  appears  a  brachycephalic  type  of 
head.  It  is  nearly  round.  The  forehead  is  full.  The 
eyes  are  set  in  the  head  to  correspond  with  its  width. 
The  nose  is  broad.  The  upper  lip  is  short.  The 
lower  jaw  is  much  broader  than  in  the  first  generation, 
and  is  evidently  shorter,  in  a  perpendicular  line. 
These  changes  result  from  the  formation  of  a  protrud¬ 
ing  forehead,  receding  chin,  and  delicate  features. 

Q.  What  must  also  be  taken  into  consideration 
besides  climate? 

A.  Modes  of  life. 

Q.  Is  the  distinction  once  made  by  anthropologists 
between  tropic  and  non-tropic  races  now  tenable? 

A.  No.  Experience  of  the  British  in  India,*  and  of 
the  Hollanders  in  Java,  has  shown  that  with  change  of 
habits  and  food  suited  to  environment,  Europeans 
may  not  only  live  in  the  tropics  with  impunity,  but 
may  improve  under  the  advantages  these  have  over 
sub-arctic  and  temperate  zones. 

Q.  To  what  are  these  possibilities  due? 

A.  To  the  consequence  of  sound  sanitation. 

Q.  What  effects  has  hygiene  had? 

A.  “The  fairest  laurel  practical  hygiene  may  boast 
of  to-day  is,’’  as  Gihon  remarks,  “doubtless  the  laurel 
acquired  in  ameliorating  the  sanitary  conditions  of  the 
European  in  tropical  climates.’’ 


ON  IRREGULARITIES  OF  THE  TEETH. 


119 


Q.  What  did  James  Lind  remark  a  century  ago? 

A.  Much  more  than  to  climate  you  are  indebted  to 
your  own  ignorance  and  negligence  for  the  disease 
from  which  you  suffer  in  tropical  climates. 

Q.  What  do  modern  researches  tend  to  show? 

A.  That  the  vital  resistance  of  the  different  races 
in  tropical  climates  depends  more  on  external  condi¬ 
tions  than  on  race. 

Q.  What  must  be  observed  by  strong,  healthy 
Europeans  of  both  sexes  to  live  in  tropical  climes? 

A.  They  must  assiduously  observe  hygienic  rules. 

Q.  What  has  been  shown  in  regard  to  sterility  of 
Europeans  in  tropical  regions  under  unchanged  habits 
of  life? 

A.  That  Europeans  are  not  able  to  produce  more 
than  three  or  four  generations  of  true  European  blood, 
and  that  from  the  third  or  fourth  generation  onward, 
sterility  is  the  rule. 

Q.  Is  there  an  opportunity  to  test  this  statement? 

A.  The  permanent  establishment  of  an  American 
colony  in  the  Philippines  will  decide  this. 

Q.  What  other  important  factors  must  be  consid¬ 
ered  in  connection  with  climate? 

A.  Dietetics,  as  well  as  moist  and  dry  heat. 

Q.  What  effects  are  these  last  liable  to  produce? 

A.  Neurasthenia,  with  co-existing  and  complicating 
auto-intoxication. 

Q.  How  do  these  two  affect  the  tissues  of  the 
mouth? 

A.  They  alter  nutrition  of  the  alveolar  process, 
producing  interstitial  gingivitis  and  absorption. 

Q.  Cite  an  illustration  of  this. 

A.  A  twenty-three-57ear-old  man  has  been  in  the 


120 


QUIZ  COMPEND 


Philippines  for  a  year  and  seven  months.  He  was 
one  of  the  first  volunteers  to  reach  Manilla  after  the 
naval  battle.  Nineteen  months’  life  in  the  tropics  on 
the  usual  army  rations  has  resulted  in  the  loss  of 
nearly  every  tooth.  While  the  climate  undermines 
the  nutrition  of  the  alveolar  process,  and  tropical 
fevers  have  the  same  effect,  improper  diet  increases 
the  defect.  The  teeth  dropped  out,  one  by  one,  as  is 
commonly  the  case  with  Americans  in  the  Philip¬ 
pines. 

Q.  How  has  the  English-speaking  race  demon¬ 
strated  its  ability  to  endure  all  climates? 

A.  The  types  now  forming  in  South  Africa  and 
Australia  recall  the  New  England  and  Kentucky  type 
of  the  eighteenth  century,  but  will  doubtless  pass,  like 
it,  into  a  type  resembling  that  of  the  fourth  generation 
illustrated. 

Q.  Is  this  race,  in  its  own  home,  mixed? 

A.  Yes.  In  its  colonies  it  is  still  more  so,  but 
despite  this,  preserves  relatively  permanent  mental 
and  physical  racial  characteristics. 

Q.  What  effect  does  the  struggle  to  maintain 
mental  states  produce? 

A.  The  variations  in  the  teeth  and  jaws  noticeably 
present  in  the  English-speaking  races. 

Q.  Where  are  similar  effects  observable? 

A.  The  Scandinavian  speaking  races,  who  resem¬ 
ble  them  in  racial  admixture  and  adaptability  to 
climate,  have  the  same  tendencies  in  relation  to  jaws 
and  teeth. 

Q.  How  is  it  evident  that  climate  does  not  exercise 
the  influence  once  claimed  for  it? 

A.  Thirty  years  ago,  government  authorities 


ON  IRREGULARITIES  OF  THE  TEETH. 


121 


claimed  it  was  impossible  for  human  beings  to  live 
the  entire  year  in  Minnesota,  owing  to  the  extreme 
cold  in  winter.  Now,  not  only  is  the  soil  cultivated 
throughout  the  entire  state,  but  still  farther  north,  in 
Manitoba,  a  large  city  has  sprung  up,  surrounded  by 
a  very  considerable  farming  population.  The  influ¬ 
ence  of  climate,  therefore,  can  be  guarded  against  by 
man  much  more  than  any  factor  of  his  environment. 

Q.  What  effect  has  altitude  on  physiologic  charac¬ 
teristics? 

A.  While,  as  a  rule,  residents  at  high  altitudes  are 
strong,  robust,  buoyant,  and  of  great  mental  and 
physical  endurance,  there  are  numerous  exceptions. 
Thus  “the  engineers  and  workmen  on  the  Jungfrau 
railway,  obliged  to  remain  a  considerable  time  at  alti¬ 
tudes  of  about  2,600  meters  above  the  sea-level,  are  lia¬ 
ble  to  a  disagreeable  complaint.  After  eight  or  ten  days 
they  are  seized  with  violent  pains  in  several  teeth,  on 
one  side  of  the  jaw,  the  gums  and  cheek  on  the  same 
side  becoming  swollen.  The  teeth  are  very  sensitive 
to  pressure,  so  that  mastication  is  extremely  painful. 
These  symptoms  increase  in  severity  for  three  days, 
and  then  gradually  and  entirely  disappear.  It  seems 
to  be  purely  a  phenomenon  of  acclimatization.  All 
newcomers  pass  through  the  experience,  and  the  dis¬ 
order  never  recurs.”  The  influence  of  heat,  of  cold, 
and  of  barometric  pressure  shown  in  a  lesser  degree 
in  “mountain  fever”  produces  systemic  disturbance 
of  metabolism,  which,  causing  auto-intoxication, 
markedly  affects  the  alveolar  process,  producing  inter¬ 
stitial  gingivitis. 

Q.  Where  are  effects  of  soil  upon  growth  most 

obvious? 

10 


122 


QUIZ  COMPEND 


A.  In  goitre  and  cretinism. 

Q.  Are  primitive  races  affected? 

A.  Unsanitary  surroundings,  depressing  constitu¬ 
tional  conditions,  improper  and  excessively  nitrogenous 
diet,  produce,  among  Indians,  goitre  and  bone  changes 
often  associated  with  it. 

Q.  How  may  the  influence  of  food  producing  sys¬ 
temic  changes  which  involve  interference  with  proper 
osseous  development  be  divided? 

A.  Into  two  factors.  One  involving  the  quality  of 
the  food,  and  the  other  its  quantity  and  variety. 

Q.  What  is  one  most  striking  illustration  of  the 
first  factor? 

A.  The  constitutional  skin,  nervous  and  mental 
disorder,  pellagra,  found  in  France  and  Italy. 

Q.  How  is  the  disorder  produced? 

A.  While  unhygienic  surroundings  play  a  part, 
pellagra  is  chiefly  due  to  spoiled  maize,  taken  as  a  food. 

Q.  Wherein  are  its  osseous  effects  evident? 

A.  The  frequency  of  jaw  and  teeth  stigmata  dem¬ 
onstrates  the  effect  of  pellagra. 

Q.  What  other  conditions  of  diet  affect  the  osseous 
system? 

A.  Monotony  of  diet  is  likewise  an  emphatic  cause 
of  constitutional  nervous  disorders,  such  as  distort 
osseous  development. 

O.  What  other  conditions  are  brought  about  by 
monotony  of  diet? 

A.  Monotony  of  diet  and  surroundings  undoubt¬ 
edly  produce  a  large  amount  of  degeneracy  in  families 
of  pioneers  in  the  United  States,  and  of  farmers  in 
secluded  valleys  of  Norway,  Switzerland,  and  else¬ 
where. 


ON  IRREGULARITIES  OE  THE  TEETH. 


123 


Q.  What  effect  has  it  upon  the  farmer  families? 

A.  There  is  an  unusual  quantity  of  insanity  in 
families,  traceable  to  this  condition. 

Q.  Cite  an  illustration. 

A.  The  mother,  a  member  of  New  England  stock, 
of  tireless  energy,  to  whom  work  was  a  pleasure  and 
rest  an  abhorrence,  lived  on  a  farm,  miles  from  the 
town.  She  did  all  her  own  work  and  brought  up 
a  large  family,  chiefly  on  maize,  potatoes,  and  bread, 
pork  being  the  mep.t  diet.  At  fifty  this  woman  re¬ 
moved  with  her  husband,  who  had  grown  wealthy,  to  a 
small  country  town.  Here  she  conducted  the  work  of 
the  household  without  a  servant.  At  fifty-two  she 
broke  down  with  neurasthenia,  which  rapidly  passed 
into  periodical  gloomy  spells,  in  one  of  which  she  com¬ 
mitted  suicide.  Her  youngest  daughter,  who  had  a 
symmetrical  face,  has  the  gloomy  tendency  of  the 
mother,  alternating  with  periods  of  restlessness, 
which  evince  themselves  unnecessarily  in  doing  the 
work  of  the  servants  and  other  labors  inconsistent 
with  her  husband’s  social  status.  She  had  at  times 
suicidal  and  homicidal  impulses.  She  has  three 
children;  one  exhibits  no  special  abnormality;  the 
eldest,  a  boy  of  eleven,  dislikes  to  play  with  boys, 
because  they  are  rough,  plays  with  girls,  to  whom  he 
is  at  times  mischievously  cruel.  He  likes  to  sew 
dolls’  clothing  and  purchase  dolls,  while  there  are 
other  indications  of  sexual  abnormality.  The  youngest, 
a  girl,  has  frequent  attacks  of  epileptic-like  fury, 
although  between  these  she  is  kind-hearted,  good- 
humored,  and  very  affectionate. 

Q.  What  does  the  fungus  on  maize  (ustilago)  like 
the  fungus  on  rye  (ergot)  produce? 


124 


QUIZ  COMPEND 


A.  A  rather  long-lasting  neurosis  of  epileptic 
character,  susceptible  of  transmission  to  the  offspring 
of  women  poisoned  with  fungi. 

Q.  What  effect  does  a  vegetarian  diet  have? 

A.  It  seems  to  be  deteriorating  to  the  races  who 
are  restricted  to  it  alone.  These  races  are  cowardly, 
meanly  cruel,  extremely  mendacious,  untrustworthy, 
weak  in  stamina,  and  readily  yield  to  morbid  influences. 

O.  What  effect  does  potato  diet  have  upon  the 
Irish  Celt? 

A.  The  influence  of  potato  diet  in  degenerating 
the  Irish  Celt  in  comparison  with  the  Scottish  Celt, 
under  the  same  conditions,  is  difficult  at  present  to 
determine,  for  lack  of  data.  Certainly  the  descendants 
of  this  class  of  Irish  Celts  rapidly  regain  a  handsome, 
healthy  status  under  mixed  American  diet,  even 
though  the  hygienic  surroundings  in  the  great  cities 
be  not  the  best. 

Q.  What  does  the  physician  find  who  undertakes 
to  treat  a  class  of  neurasthenics,  in  whom  starch  diges¬ 
tion  is  impaired? 

A.  He  finds  that  a  diet  of  potatoes  (undoubtedly 
through  the  auto-intoxication  it  produces)  will  increase 
certain  nervous  symptoms,  and  hence  the  tendency 
to  transmission  to  the  next  generation. 

Q.  How  is  this  widespread  influence  of  nutrition 
excellently  illustrated? 

A.  In  the  conditions  produced  in  children,  and  in 
the  insane,  by  improper  food,  and  the  reaction  of 
these  to  hygienic  diet. 

Q.  What  may  improper  diet  produce  in  the  child? 

A.  It  will  produce  all  possible  nervous  disorders, 
including  those  involving  the  trophic  processes. 


ON  IRREGULARITIES  OF  THE  TEETH. 


125 


Q.  In  what  diseases  is  this  peculiarly  evident? 

A.  Scurvy  and  rickets  and  their  effects  on  the  gen¬ 
eral  osseous  development.  Improper  maternal  diet 
during  pregnancy  may  produce  similar  effects. 

Q.  Has  the  influence  of  maternal  environment 
upon  the  foetus  been  much  underrated? 

A.  Yes.  Because  of  the  belief  that  the  placenta, 
by  its  filtering  and  poisoning-destroying  functions, 
protected  the  foetus. 

Q.  Has  this  been  shown  to  be  an  error? 

A.  Yes.  Especially  in  arrests  of  development 
produced  by  the  toxins  of  the  great  contagions. 

O.  What  did  later  investigations  show? 

A.  That  not  only  did  organic  poisons,  like  opium, 
pass  through  the  placenta,  but  that  mineral  poisons, 
like  lead,  did  also.  Children  of  opium  using  mothers 
died  in  the  first  months  after  birth,  unless  given 
opium.  It  was  later  shown  that  in  such  cases  the 
umbilical  cord  contained  large  quantities  of  morphine. 

O.  What  is  known  as'  to  children  of  mothers  work- 
ing  in  tobacco  factories? 

A.  They  exhibited  very  little  vitality,  and  much 
deformity. 

Q.  What  effect  has  tobacco-working  on  maternity? 

A.  Maternal  work  in  tobacco  factories  is  a  cause  of 
frequent  miscarriage,  of  high  infantile  mortality,  of 
defective  children,  and  of  infantile  convulsions. 

Q.  What  has  been  observed  in  regard  to  mineral 
poison? 

A.  Lead  and  phosphorus  pass  through  the  placenta 
and  enter  the  child’s  circulation. 

O.  What  is  the  effect  upon  the  system? 

A.  It  has  been  found  that  those  exposed  to  its 


126 


QUIZ  COMPEND 


fumes  have  systemic  nervous  exhaustion,  character¬ 
ized  by  local  paralysis  about  the  wrist,  as  well  as  the 
general  symptoms  of  profound  systemic  nerve-tire. 

Q.  What  may  happen? 

A.  This  may  result  in  acute  insanity  of  the  con- 
fusional  type,  followed  very  often  by  forms  of  mental 
disorder  of  a  chronic  type  resembling  paretic  dementia. 

Q.  What  may  follow  should  there  be  a  recovery? 

A.  Epilepsy;  in  other  cases,  an  irritable  suspicional 
condition  results,  in  which  the  patient  may  live  for 
years,  marry,  and  leave  offspring.  This  last  condition 
and  the  epileptic  are  the  most  dangerous  as  to  the 
production  of  degeneracy* 

Q.  Give  an  example. 

A.  Women  employed  in  the  pottery  factories  suffer 
from  a  form  of  lead  poisoning,  which  produces  decid¬ 
edly  degenerative  effects  upon  the  offspring.  These 
women  have  frequent  abortions,  often  produce  deaf- 
mutes,  and  very  frequently  macrocephalic  idiots. 

Q.  What  effect  does  brass  dust  have  upon  work¬ 
men? 

A.  They  suffer  from  a  very  similar  condition  to 
that  produced  by  lead.  Grave  forms  of  nervous 
exhaustions  occur  among  brass  workers. 

Q.  Do  women  become  exposed  to  these  conditions? 

A.  Yes.  The  effect  produced,  so  far  as  the  off¬ 
spring  has  been  observed,  are  frequent  abortions  and 
infantile  paralysis. 

Q.  What  effect  has  mercury  upon  the  system? 

A.  It  produces  systemic  nervous  exhaustion,  in 
which  the  most  marked  symptom  is  tremor,  amount¬ 
ing  at  times  to  shaking  palsy. 

Q.  What  effect  does  this  have  upon  the  offspring? 


*  4 

ON  IRREGULARITIES  OF  THE  TEETH,  127 

A.  Like  all  other  nervous  exhaustions,  the  mer¬ 
curial  one  may  appear  as  degeneracy  in  the  offspring. 

Q.  What  is  the  effect  upon  women  who  work  in 
match  factories? 

A.  The  chief  toxic  effect  of  phosphorus  is  not  the 
localized  jaw  necrosis.  This  is  an  evidence  of  the  pro¬ 
gressive  system-saturation  with  phosphorus.  It  bears 
the  same  relation  to  the  dangerous  effect  of  phos¬ 
phorus  that  “blue  gum”  does  to  the  systemic  effects 
of  lead. 

Q.  What  is  the  effect  of  carbon  bisulphide? 

A.  Those  who  come  in  contact  with  it  have  been 
noted  to  suffer  from  the  initial  stages  of  interstitial 
gingivitis.  Recently  cases  are  reported  where  twenty 
young  women,  employed  in  rubber  factories,  exhibited 
a  necrotic  process  in  the  jaws  and  teeth  similar  to  that 
resultant  on  phosphorus. 


< 


CHAPTER  XIII. 


RACE  ADMIXTURE. 

Q.  Is  race  admixture  slight? 

A.  It  has  been  greatly  underestimated. 

O.  To  what  is  this  due? 

A.  Ethnic  researches  have  lately  thrown  much 
doubt  on  the  standards  set  up  as  race  tests. 

Q.  What  has  been  assumed? 

A.  That  a  clear  distinction  can  be  made  on  philo- 
logic  grounds  between  different  races,  and  that  even 
Aryan-speaking  races  can  be  easily  separated. 

Q.  Can  this  be  accomplished? 

A.  Ethnology  has  shown  this  to  be  an  error,  and 
that  speech  is  no  test  of  race. 

Q.  Are  the  races  of  Europe  pure? 

A.  No.  Not  merely  are  the  Aryan-speaking  races 
of  Europe  mixed  together,  but  the  blood  of  all  has  a 
pre- Aryan  and  a  Turanian  dash. 

O.  How  far  back  do  these  admixtures  date? 

A.  To  palaeolithic  times,  when,  although  the  pre¬ 
dominant  type  of  skull  was  dolichocephalic  (or  long¬ 
headed),  brachycephalic  (round-headed  type)  had 
begun  to  appear  in  America,  then  connected  by  land 
with  both  Africa  and  Europe.  In  subsequent  neo¬ 
lithic  times,  while  the  type  is  at  first  generally 
brachycephalic,  it  soon  becomes  mesocephalic  (mixed 
long  and  round  headed),  pure  brachycephalic  and 
dolichocephalic  becoming  rare. 

129 


130 


QUIZ  COMPEND 


Q.  Is  this  race  admixture  true  6f  American 
Indians? 

A.  Even  the  race  type  called  the  American  Indian 
still  so  retains  traces  of  the  race  elements  forming  it 
in  the  pleistocene  period  that  these  elements  are  yet 
distinguishable  by  ethnologists. 

O.  Toward  what  does  the  American  Indian  lean 
in  nose  types? 

A.  Its  proto-caucasic,  rather  than  its  proto-mon- 
golic  or  proto-negroid  elements. 

Q.  How  many  types  appear  in  Great  Britain  and 
Ireland? 

A.  These  types  and  traces  of  their  blood  are  still 
detectable  in  living  man.  The  neolithic  race  in  Great 
Britain  was  dark,  of  feeble  build,  short  stature,  with 
dolichocephalic  skulls.  This  race  remained  to  the 
historic  period  as  the  Silures  in  Great  Britain  and 
the  Firbolgs  in  Ireland.  It  had  high  cheek  bones  and 
oblique  eyes.  Toward  the  middle  of  the  neolithic 
period  this  race  was  conquered  by  a  brachycephalic, 
tall,  long-armed,  muscular  race,  with  florid  com¬ 
plexion  and  yellowish  or  red  hair.  The  third  race 
which  invaded  Great  Britain  was  of  fair  complexion 
with  prognathous  jaws,  dolichocephalic  skull,  of  tall 
stature,  great  bones,  great  chest  development,  and 
massive  jaws. 

Q.  Are  there  any  pure  races  at  the  present  time? 

A.  As  the  intermingling  of  races  began  early,  the 
question  of  the  existence  of  pure  races  to-day,  or  even 
during  the  historic  period,  is  an  open  one. 

O.  Are  the  Hebrews  pure? 

A.  They  have  been  comparatively  pure  since  the 
return  from  the  captivity.  Before  that,  as  the  history 


ON  IRREGULARITIES  OF  THE  TEETH. 


131 


of  Solomon’s  foreign  marriages  demonstrates,  they 
were  a  raceless  chaos,  the  Semitic  element  predom¬ 
inating. 

Q.  Who  were  the  Copts,  or  ancient  Egyptians? 

A.  They  were  a  mixture  of  Turanian,  Hamite, 
Aryan  and  Semite  peoples  imposed  on  a  negroid  basis. 

O.  What  occurred  when  these  elements  were 
finally  fused? 

A.  The  race  bred  relatively  true,  although  the 
lower  classes  tended  to  the  negroid  type  and  the 
higher  to  the  Caucasic. 

Q.  Of  what  do  the' Coreans  consist? 

A.  A  mixture  of  two  primitive  races,  one  white, 
the  other  yellow. 

O.  The  Japanese? 

A.  Their  ancestors  emigrated  to  Japan  from  Corea. 
They  are  products  of  the  addition  of  two  distinct  types 
to  that  forming  their  Corean  ancestors.  The  Polyne¬ 
sian,  to  a*  great  extent,  and  the  Malay,  to  a  greater,  are 
mixed  with  the  original  Corean. 

0.  The  Chinese? 

A.  The  Chinese  are  neither  a  homogenous  people 
nor  a  pure  race,  albeit  the  relatively  few  Mantchus 
are  dominant. 

Q.  The  Indian  Aryans? 

A.  They  are  known  to  be,  despite  a  rigid  caste  sys¬ 
tem,  a  non-Aryan  race,  feebly  infused  with  a  modicum 
of  Aryan  blood. 

Q.  What  of  the  so-called  “Gypsy?” 

A.  The  so-called  “Gypsy”  seems,  of  all  the  races  of 
India,  to  have  retained  most  Aryan  speech  and  type 
as  well  as  original  Aryan  semi-nomadic  wagon- 
journeying  in  the  midst  of  settled  civilization.  Ghetto 


132 


QUIZ  COMPEND 


seclusion  long  helped  to  preserve  relative  purity  of 
race  in  the  Jew,  but  despite  vagabond  surroundings, 
the  ‘"Gypsy”  has  remained  even  purer. 

Q.  With  the  three  races  described  as  mingling  in 
Great  Britain  and  Ireland,  has  not  even  greater 
admixture  occurred  at  a  later  period? 

A.  Yes.  The  so-called  Scotch-Irish  (whose  blood 
enters  so  largely  in  the  dominant  race  of  the  United 
States),  despite  their  speech  (much  more  Teutonic 
and  monosyllabic  than  English)  are  a  raceless  chaos 
of  Gaelic  and  Cymric  Celts,  Lowland  Scotch,  French 
Huguenots,  Danes  (Celto-Teuto-Slavs),  Palatinate 
Germans,  Magyars,  English  Puritans,  Hollanders, 
Swedes,  Protestant  Italians,  Poles,  and  Spaniards. 

Q.  How  has  a  marked  variation  in  type  been  pro¬ 
duced  in  the  British  Isles? 

A.  The  intermixture  of  the  dark,  small-boned, 
dolichocephalic,  orthognathous  (with-in-drawn  jaws) 
lace,  with  the  brachycephalic,  prognathous,  big¬ 
boned,  red-haired,  and  then  with  dolichocephalic, 
piognathous,  deep-chested,  big-boned,  fair  race,  pro¬ 
duced  in  the  British  Isles  as  marked  variations  in  type 

as  now  occur  from  the  admixture  of  the  Indian  and 
the  Negro. 

Q.  What  exerted  a  great  influence  in  the  British 
Isles? 

A.  While  religion  played  a  part,  war,  commerce 
and  art  also  exerted  an  influence.  Thus  Bunyan,  the 
author  of  the  “Pilgrim’s  Progress,”  was  the  descend¬ 
ant  of  Bunyano,  an  Italian  architect,  imported  to 
build  Melrose  Abbey.  The  destruction  of  the  Spanish 
Armada  introduced  Spanish  elements  all  along  the 
West  and  East  coasts  of  England,  Ireland  and  Scot- 


ON  IRREGULARITIES  OF  THE  TEETH. 


133 


land.  The  capture  of  Calais  by  the  French  from  Mary 
Tudor  added  a  French  colony  to  London. 

Q.  What  of  the  Scandinavian  race? 

A.  The  primitive  race  called  the  Quens  was  of 
Esquimo  type.  This  race  was  first  intermixed  with 
a  tall,  long-armed,  brachycephalic,  muscular  race  with 
florid  complexion  and  yellowish  or  red  hair.  The  race 
resultant  on  this  mixture  was  later  fused  with  a  third 
having  prognathic  jaws,  large  dolichocephalic  skulls, 
tall  stature,  great  bones,  great  chest  development,  but 
small  hands  and  high  arched  feet.  After  these  race 
admixtures  had  formed  the  Scandinavians,  who 
became  the  sea  kings,  the  intermixture  with  other 
races  still  continued.  Around  Bergen,  Norway,  was 
an  Irish  colony  with  well  formed,  delicate  features, 
brunette  complexion,  oblique  blue  eyes  and  black  hair. 
The  influence  of  this  colony  is  still  demonstrable. 

Q.  What  effect  did  these  different  types  of  skull 
and  face  have  upon  the  English-speaking  and  Scandi¬ 
navian-speaking  peoples? 

A.  The  contest  for  existence  (between  the  organs 
of  men)  centered  itself  with  peculiar  intensity  on 
structures  which,  like  the  jaws  and  teeth,  are  so  vari¬ 
able  with  rise  in  the  scale  of  evolution. 

O.  What  would  be  the  effect  on  the  scion  of  an 
orthognathic  mother  and  prognathic  father? 

A.  He  would  have  marked  irregularities  of  the  jaws 
and  teeth,  destitute  of  the  significance  of  the  depth 
of  degeneracy  implied  by  the  same  irregularities  in  a 
purely  prognathic  or  orthognathic  race. 

Q.  What  caused  an  intense  struggle  for  existence 
in  such  a  mixed  race? 

A.  Food  which  exacted  less  active  functions  on  the 


134 


QUIZ  COMPEND 


part  of  the  jaws  and  teeth  in  such  a  mixed  race  would 
imply  an  intense  struggle  for  existence  between  the 
different  teeth,  and  this  struggle  would  proceed 
with  greater  or  lesser  intensity  as  the  organism  was 
or  was  not  affected  by  that  constitutional  nerve  strain 
which  precedes  general  degeneracy. 

Q.  What  effect  do  the  different  factors  produce 
on  the  constitution? 

A.  They  create  a  general  loss  of  nerve  tone  which 
relieves  the  local  nerve  systems  of  control  by  the  cen¬ 
tral  nerve  system. 

Q.  What  becomes  of  these  local  nerve  sys¬ 
tems? 

A.  They  take  on  feverish  activity  in  consequence 
and  become  themselves  exhausted. 

Q.  In  what  way  would  this  affect  the  jaws  and 
teeth? 

A.  In  proportion,  therefore,  as  the  general  nervous 
system  has  control  would  the  evolution  of  the  teeth 
and  jaws,  in  their  relation  to  the  organ  struggle  for 
existence,  proceed  with  regularity. 

Q.  What  influence  would  food  have  under  these 
conditions? 

A.  The  influence  of  food,  while  beneficial  to  the 
organism  as  a  whole,  may,  as  already  pointed  out, 
introduce  a  struggle  for  existence  between  the  teeth, 
causing  local  degenerations  of  these  and  the  jaws. 

Q.  If  man  used  his  jaws  and  teeth  as  a  weapon  of 
®ffense  and  defense,  would  the  soft  foods  alone  cause 
degeneracy? 

A.  The  employment  of  the  teeth  and  jaws  as 
weapons  would  prevent  that  degeneracy  as  a  jaw 
otherwise  consequent  upon  decreased  use  resultant  on 


ON  IRREGULARITIES  OF  THE  TEETH. 


135 


a  change  from  vegetable  and  nut  diet  to  the  more 
easily  digested  and  masticated  meat  or  fish  diet. 

Q.  What  indicates  that  such  use  of  the  jaw 
interfered  with  degeneracy? 

A.  The  persistence  of  prognathism  in  races  as  high 
as  those  described,  even  when  brachycephalic,  is  an 
indication  that  the  use  of  the  jaw  as  a  weapon  inter¬ 
fered  with  its  degeneracy  consequent  on  improved 
food. 

Q.  What  does  the  vermiform  appendix  indicate? 

A.  While  man  was  a  vegetable  feeder,  the  atrophic 
tendency  of  the  vermiform  appendix  shows  that  he 
early  became  a  user  of  animal  food,  albeit  not  to  the 
extent  of  carnivorous  mammals,  in  whom  the  appendix 
has  disappeared. 

Q.  How  did  this  change  affect  the  jaws  and  teeth? 

A.  This  change  initiated  a  tendency  to  variability 
in  the  jaws  and  teeth. 

Q.  Are  such  changes  demonstrable  in  America? 

A.  This  variability  is  excellently  shown  in  four 
generations  of  so-called  “Anglo-Saxon”  Americans  of 
the  Knickerbocker  type.  The  first  is  a  probably 
neolithic  Hollander  type  with  low,  receding  negroid 
forehead,  small,  sunken  eyes,  protruding  nose  and 
upper  lip,  cheek  bones  prominent,  receding  lower 
jaw.  The  second  was  born  of  the  previous  type, 
settled  in  New  York.  The  change  in  climate  has 
altered  the  face  considerably.  The  forehead  is  higher, 
broader  and  more  prominent.  The  eyes  are  large  and 
not  so  deeply  set.  The  cheek  bones  are  not  so  prom¬ 
inent,  nose  and  upper  jaw  less  prominent,  upper  lip 
longer,  chin  the  same.  Admixture  of  race  types  has 

produced  a  forehead  broad  and  full,  eyes  less  sunken, 

11 


136 


QUIZ  COMPEND 


recession  of  cheek  bones,  nose  and  upper  jaw;  upper 
lip  same;  lower  jaw  broader,  anterior  position  same. 
Here  the  forehead  is  still  broader,  more  prominent, 
higher;  large  round  eyes.  There  is  more  recession 
•  of  the  cheek  bones.  The  nose  and  upper  jaw  are  the 
same.  The  face  is  broader,  lower  jaw  broader  and 
anterior  position  same. 

Q.  Of  what  is  this  variability  an  expression? 

A.  The  law  of  economy  of  growth  whereby  an 
organ,  under  the  influence  of  the  struggle  for  existence, 
degenerates  from  the  ideal  type  of  the  organ  as  an 
organ  for  the  benefit  of  the  organism  as  a  whole.  This 
variability  along  local  lines  of  degeneracy  seeks  pecul¬ 
iarly  the  line  of  least  resistance  in  the  jaws  and  teeth. 

Q.  What  is  the  tendency  in  race  admixture? 

A.  The  tendency  in  race  admixture  (when  the  new 
blood  is  of  stocks  with  large  jaws  and  regular  teeth) 
is  to  stamp  out  local  influences  which  tend  to  produce 
arrest  of  development  and  irregular  teeth.  By  con¬ 
stant  race  admixture  the  jaws  retain  their  normal  reg¬ 
ular  shape.  The  tendency  of  the  child  to  inherit  the 
small  jaws  of  one  and  the  large  teeth  of  the  other,  or 
vice  versa,  is  a  fruitful  source  of  facial  and  jaw 
deformity. 


CHAPTER  XIV. 


CONSTITUTIONAL  DISORDERS. 

Q.  From  what  two  standpoints  must  the  influence 
of  constitutional  disorders  on  the  development  of  the 
skull  and  face  be  viewed? 

A.  First,  from  the  standpoint  of  the  mother  af¬ 
fected  during  pregnancy;  and  second,  from  the  stand¬ 
point  of  the  foetus  affected  during  intra-uterine  life,  or 
of  the  child  affected  precedent  to  or  during  the  periods 
of  stress. 

Q.  How  may  constitutional  disorders, especially  the 
infections,  affect  the  mother? 

A.  In  the  bony  mal-development  shown  to  occur  in 
animals  by  Charrin  and  Gley,  and  in  man  by  Coolidge. 

Q.  Are  facial  bones  jaws,  and  teeth  peculiarly 
liable  to  this? 

A.  They  are. 

Q.  What  will  be  the  effect  upon  the  foetus,  even  if 
the  disease  in  the  parent  be  but  temporary? 

A.  Foetal  development  may  be  checked  as  to 
higher  tendencies;  thus  mothers  have  borne  moral 
imbeciles,  epileptics,  kmatics,  or  deformed  children 
after  a  pregnancy  during  which  they  were  attacked 
by  contagious  disease.  The  children  of  subsequent 
and  previous  pregnancies  were  normal. 

Q.  What  has  been  observed  in  regard  to  children 
before  and  after  contagious  diseases? 

A.  The  children  of  pregnancies  previous  to  the  one 
complicated,  by  contagious  disease  may  be  healthy, 

137 


138 


QUIZ  COMPEND 


while  those  of  subsequent  pregnancies  are  defec¬ 
tive. 

Q.  How  may  contagious  and  infectious  diseases 
affect  bodily  strength? 

A.  Any  contagious  and  infectious  disease  may  not 
only  interfere  temporarily  with  the  bodily  strength, 
but  may  produce  complete  change  in  the  parent’s 
system,  extending  even  to  the  highest  acquirement  of 
man. 

Q.  How  are  the  nerve  centers  affected? 

A.  The  nerve  centers  controlling  nutrition, growth, 
repair,  secretion,  and  excretion  are  often  as  deeply 
affected  as  those  checks  constituting  morality.  At  the 
periods  of  physiologic  stress  these  effects  are  especially 
noticeable. 

Q.  Specify  them? 

A.  Moral  insanity,  intellectual  insanity,  unequal 
mental  balance,  hysteria,  precocious  sexuality,  uncon¬ 
scious  mendacity,  mental  parasitism  (the  germ  of  pau¬ 
perism),  epilepsy,  neuroses,  and  all  types  of  nutritive 
and  constitutional  defects  result. 

Q.  Where  may  the  nutritional  defects  appear? 

A.  Chiefly  in  the  walls  of  the  blood  vessels  and 
lymphatics,  as  in  scurvy,  mercurial  poisoning,  etc. 

Q.  While  these  occur  in  the  chronic  infections  and 
contagions,  where  do  they  also  result? 

•  A.  In  acute  typhoid  fever,  scarlatina,  diphtheria, 
whooping  cough,  etc. 

Q.  How  do  these  affect  the  blood? 

A.  Proper  blood  supply,  utilization  and  elimina¬ 
tion  of  waste  are  thus  prevented. 

Q.  Can  organs  then  perform  their  functions? 

A.  They  cannot.  They  are  predisposed  to  disease 


ON  IRREGULARITIES  OF  THE  TEETH. 


139 


from  disuse  and  from  weakness  of  the  disease-fighting 
phagocytes  and  antitoxins. 

Q.  What  results? 

A.  Irregularity  of  organ  functions,  which  is  hered¬ 
itarily  transmissible. 

Q.  What  becomes  of  the  weakened  vessel-walls? 

A.  They  yield  to  strain,  and  thus  produce  local 
stomach,  bowel,  liver,  gland,  and  kidney  disorders. 

Q.  Is  this  weakness  completely  transmissible? 

A.  It  alone  may  be  transmissible  to  the  offspring. 

Q.  May  the  ductless  glands  be  affected? 

A.  The  functions  of  the  great  ductless  glands 
(thyroid,  thymus,  adrenals,  pituitary  body,  bone- 
marrow,  etc.),  which  secrete  principles  necessary  to 
the  equal  balance  of  nutrition,  are  perverted. 

Q.  What  effect  does  perverted  nutrition  have  upon 
the  system? 

A.  The  liver  in  the  acute,  but  more  particularly  in 
the  chronic,  contagions,  paralyzed  in  nerve  tone,  fails 
in  its  functions,  nutritive  and  poisoning-destroying,  as 
for  the  same  reason  the  kidneys  fail  in  their  power  of 
ejecting  hurtful  waste. 

Q.  What  effect  does  nerve  exhaustion  have? 

A.  Nerve  exhaustion,  with  its  suspicion,  its  capric¬ 
ious  hopefulness  and  gaiety,  is  practically  continuous  in 
tuberculosis,  syphilis,  and  leprosy. 

Q.  How  is  the  bony  and  dental  development 
affected? 

A.  In  a  general  way  the  influence  resembles  that 
of  syphilis. 

Q.  How  is  this  influence  exerted? 

A.  In  two  ways.  First,  on  the  individual,  which 
may  affect  development  of  the  bones  or  teeth  if  it 


140 


QUIZ  COMPEND 


occur  during  the  periods  of  evolutionary  stress.  Syph¬ 
ilis  contracted  during  infancy  thus  affects  the  develop¬ 
ment  of  the  teeth.  The  same  is  true  of  all  infectious 
diseases  to  a  greater  or  lesser  extent,  and  is  likewise 
true  of  conditions  like  scurvy  and  rickets.  In  a  gen¬ 
eral  way  also,  the  influence  of  the  contagious  diseases, 
as  exerted  on  the  descendants,  is  of  two  types.  Firstly, 
the  direct  transmission  of  the  disorder,  which  must  be 
regarded  as  intra-uterine,  and  secondly,  the  transmis¬ 
sion  from  the  ancestor  to  the  descendant  of  sundry 
pathologic  characters  having  nothing  specific  per  se,but 
consisting  perchance  in  native  inferiorities  of  constitu¬ 
tion,  of  temperament,  of  vital  resistance,  perchance  in 
retardations,  arrests,  or  imperfections  of  development, 
mental,  physical,  or  manifested  in  organic  changes; 
either  malformations  of  organs  or  monstrosities. 

Q.  What  is  the  first  of  those  heredities  properly 
called? 

A.  Syphilitic,  typhoid,  or  small-pox  heredity. 

Q.  What  is  the  second  called? 

A.  The  second  has  received  several  synonymous 
titles;  parasyphilitic  (typhoid,  etc.)  heredity,  dystro¬ 
phic  heredity,  or  toxaemic  heredity. 

Q.  In  the  last  the  toxins  produced  by  germs,  or  the 
poisons  produced  by  maternal  nutritional  defects,  cause 
what? 

A.  The  arrests,  retardations,  imperfections  of 
development  seen  in  the  children  of  otherwise  healthy 
mothers  suffering  from  the  infections  and  contagions, 
or  from  nutritional  disorders  or  defects,  just  precedent 
to  or  during  the  period  of  pregnancy  or  during  the 
period  of  lactation. 


ON  IRREGULARITIES  OF  THE  TEETH.  141 

Q.  During  the  periods  of  stress  what  effect  have 
these  toxins  or  allied  substances? 

A.  They  cause  the  bony  and  dental  arrests,  retard¬ 
ations,  and  imperfections  of  development  so  frequently 
noticed  after  scarlatina,  pneumonia,  cerebro-spinal 
meningitis,  etc.,  as  well  as  rickets  and  allied  condi¬ 
tions  occurring  during  infancy  and  childhood. 

Q.  How  are  the  regenerative  processes  affected? 

A.  All  the  tissues  are  below  par  in  constitutional 
diseases.  Hence  wounds  do  not  heal  as  readily  in  a 
person  the  subject  of  constitutional  diseases. 

Q.  What  relation  has  embryonal  tissue  to  repair? 

A.  The  development  of  tissue  from  an  embryonal 
type  to  mature  tissue  is  identical  with  the  regenerative 
process  in.  the  healing  of  wounds. 

Q.  How  is  the  energy  of  the  organism  expended? 

A.  In  repelling  the  advances  and  barring  the 
further  progress  of  the  micro-organisms  or  other 
causes  of  constitutional  diseases. 

Q.  What  is  the  consequence? 

A.  Warfare  between  the  cells  and  microbes.  The 
tissue  cells  that  are  regenerated  do  not  increase  the 
size  of  the  organs  as  in  normal  development. 

Q.  What  do  these  constitutional  diseases  cause? 

A.  Arrest  of  development  which  may  become  per¬ 
manent  from  the  time  of  the  disease. 

Q.  What  effect  does  this  sometimes  have  upon  the 
child? 

A.  It  stops  development  for  one  or  more  years,  and 
frequently  development  will  not  proceed  until  the 
child  is  taken  to  another  climate. 

Q.  What  effect  does  it  have  upon  the  jaws  and 
teeth? 


142 


QUIZ  COMPEND 


A.  Anomalies  of  the  jaws  and  teeth  result.  When 
arrest  of  development  of  the  teeth  takes  place,  pits 
and  furrows  are  often  found  in  the  enamel. 

Q.  What  do  these  pits  and  furrows  indicate? 

A.  The  exact  period  when  the  arrest  of  develop¬ 
ment  took  place. 

Q.  What  kind  of  teeth  especially  result? 

A.  Hutchinson’s  teeth. 

Q.  What  effect  do  the  eruptive  fevers  have  upon 
children? 

A.  They  tend  to  leave  the  system  in  a  neurotic  con¬ 
dition. 

Q.  Do  children  always  recover? 

A.  Children  who  before  were  apparently  healthy 
are  after  these  diseases  sickly  and  ailing  for  years,  and 
sometimes  never  wholly  recover. 

Q.  How  are  they  affected? 

A.  The  eyes  and  ears  and  not  infrequently  the 
organs  of  speech  are  affected.  The  eyes  remain  weak, 
occasionally  the  patient  becomes  nearly  or  quite  blind. 
The  hearing  is  frequently  permanently  impaired;  occa¬ 
sionally  the  nerve  centers  which  preside  over  the 
development  of  the  osseous  system.  There  is  a  gen¬ 
eral  arrest  of  development  of  the  whole  body.  Such 
persons  not  infrequently  remain  sickly,  neurotic,  or 
morally  imbecile.  While  they  may  regain  health,  the 
body  ceases  to  develop  normally. 

Q.  Cite  illustrations. 

A.  A  young  girl,  now  twenty,  born  of  apparently 
healthy  parents,  had  a  severe  attack  of  scarlet  fever 
at  the  age  of  seven  years.  Arrest  of  development  of 
the  upper  jaw,  and  a  V-shaped  arch  developed;  she 
has  been  near-sighted  ever  since  and  now  has  very 


ON  IRREGULARITIES  OF  THE  TEETH. 


143 


weak  eyes;  stopped  growing  for  three  years.  She 
was  taken  to  California  and  Europe  and  has  now 
regained  her  full  growth.  A  boy,  now  fourteen,  had 
pneumonia  at  the  age  of  four.  Arrest  of  development 
of  the  bones  of  the  face  is  very  marked;  he  has 
stopped  growing  and  is  now  very  small  for  his  age. 
A  young  lady,  now  twenty-three  years  of  age,  had 
scarlet  fever  at  the  age  of  four,  with  a  resultant  deaf- 
mutism.  The  bones  of  the  face  and  jaws  are  undevel¬ 
oped.  She  possesses  a  marked  V-shaped  arch.  The 
pits  and  grooves  upon  her  teeth  denote  the  age  when 
she  had  the  disease.  She  has  developed  into  a  very 
handsome,  full  grown  woman.  A  lady,  now  forty- 
five  years  of  age,  had  scarlet  fever  at  three  years. 
Her  eyes  became  inflamed  and  she  lost  her  sight  for 
twenty-four  years,  when  they  gradually  grew  better. 
The  bones  of  the  face  were  arrested  in  development. 

Q.  When  may  this  arrest  take  place? 

A.  At  any  period  up  to  the  time  of  full  growth. 

Q.  When  must  arrest  of  the  jaws  take  place  to  pro¬ 
duce  dental  deformities? 

A.  Arrest  of  development  of  the  jaws  due  to  con¬ 
stitutional  diseases  must  occur  prior  to  the  sixth 
year. 

Q.  How  is  this  modified? 

A.  By  the  influence  of  the  constitutional  disorders 
of  the  hypophysis,  which  may  lead  to  the  excessive 
development  of  bony  tissue  anywhere,  occur  to  an 
extreme  extent  in  acromegaly,  giantism,  etc. 

Q.  To  what  are  arrests  of  development,  charged  to 
specific  diseases,  sometimes  due? 

A.  They  are  in  reality  due  to  toxaemic  or  nutri¬ 
tional  causes. 


144 


QUIZ  COMPEND 


Q.  To  what  is  the  “old  man”  appearance  of  con¬ 
genital  syphilis  of  the  child  due? 

A.  It  is  due  to  arrest  of  development  of  the  foetus 
at  the  4^  month  of  intra-uterine  life;  the  so-called 
senile  period. 

Q  May  not  this  arrest  of  development  be  caused 
by  conditions  other  than  syphilis? 

A.  Yes. 

Q.  What  other  expression  of  degeneracy  is  partic¬ 
ularly  apt  to  occur  around  the  period  of  stress? 

A.  That  condition  known  as  haemophilia,  which  is 
an  hereditary  constitutional  defect  evincing  itself 
from  deficient  coagulability  in  a  tendency  to  uncon¬ 
trollable  bleeding,  either  spontaneously  or  from  slight 
wounds. 

Q.  What  is  it  sometimes  associated  with? 

A.  Sub-oxidization  conditions  like  arthritis  and 
lipomatosis.  This  diathesis  has  long  been  known. 

Q.  What  rule  did  Nasse  give? 

A.  As  a  rule  the  mother  of  the  haemophile  is  not 
a  “bleeder”  herself,  but  is  the  daughter  of  one.  The 
daughters  of  a  haemophile,  though  healthy,  transmit 
the  diathesis  to  the  male  offspring. 

Q.  When  does  haemophilia  generally  appear? 

A.  After  slight  injuries  during  the  period  of  the 
first  dentition. 

Q.  Give  some  illustrations. 

A.  The  Appleton  Swain  family  of  Reading,  Mass., 
has  had  “bleeders”  for  two  centuries.  Osier  has 
reported  instances  in  the  seventh  generation.  Kolster, 
who  has  investigated  haemophilia  in  women,  reports 
a  case  in  the  daughter  of  a  female  haemophiliac.  On 
his  analysis  of  fifty  genealogic  trees  of  haemophiliac 


ON  IRREGULARITIES  OF  THE  TEETH. 


145 


families,  it  is  evident  that  Nasse’s  law  of  transmission 
is  not  absolute.  In  fourteen  cases  the  transmission 
was  direct  from  father  to  child  and  in  eleven  cases  it 
was  direct  from  mother  to  infant. 

Q.  How  are  haemorrhagic  symptoms  of  bleeders 
divided? 

A.  Into  exterior  bleedings,  either  spontaneous  or 
traumatic,  interstitial  bleedings,  petechiae,  ecchy- 
moses,  and  joint  affections.  External  bleedings  are 
seldom  spontaneous,  but  generally  follow  cuts,  bruises, 
scratches. 

Q.  Are  operations  on  bleeders  dangerous? 

A.  Yes.  A  minor  operation  may  prove  fatal.  So 
slight  an  operation  as  extraction  of  a  tooth  has  been 
followed  by  the  most  disastrous  consequences.  Gum 
lancing  is  equally  dangerous. 

Q.  What  can  be  said  of  bleeding  families? 

A.  They  are  often  multiparous,  healthy  looking 
and  have  fine  skins.  They  are  hence  not  suspected 
of  “bleeding”  tendencies  by  the  practitioner  who 
sees  them  for  the  first  time. 


i 


i 


CHAPTER  ,  XV. 


INTELLECTUAL  AND  MORAL  DEFECTS. 

Q.  Upon  what  do  most  mental  and  moral  defects 
depend? 

A.  Upon  brain  malformation.  There  is  a  complete 
transition  from  the  durencephalic  monster,  the  micro¬ 
cephalous,  the  idiot,  the  imbecile,  and  the  feeble¬ 
minded  to  the  normal  person. 

Q.  What  neurotics  approximate  the  normal? 

A.  Sentimentalists,  pessimists,  neurotics,  hys¬ 
terics,  neuropaths,  epileptics,  drug  habitues,  tramps, 
and  prostitutes. 

Q.  Are  jaw  and  tooth  defects  found  in  these 
classes? 

A.  Yes.  Because  of  the  struggle  for  existence 
between  the  brain  and  the  face,  defect  is  more  or  less 
shown  in  the  face  structures. 

Q.  What  expressions  of  defects  are  found  in  these 
classes? 

A.  The  prostitutes,  while  furnishing  a  larger  pro. 
portion,  furnish  the  same  types  as  all  the  other  classes. 
In  them  skull  types  present  deformities  to  the  extent 
of  44 p&r  cent.  This  is  less  than  the  percentage 
among  idiots,  but  greater  than  the  percentage  among 
the  other  defective  classes.  There  were  42^  per 
cent,  of  face  deformities,  which  would  probably  be  the 
average  of  the  other  classes.  There  were  42  per  cent, 
of  the  ear  anomalies  and  54  per  cent,  of  tooth  and 
jaw  anomalies.  As  in  the  insane,  idiots,  criminals, 

147 


148 


QUIZ  COMPEND 


and  hysterics,  there  was  marked  anomaly  of  the  ex¬ 
ternal  occipital  protuberance.  Among  the  abnormal 
skull  types  presented  three  were  prominent.  In  the 
first  the  head  was  flattened  at  the  vertex,  the  fore¬ 
head  was  hydrocephalic,  the  nose  flat,  and  the  lobe  of 
the  ear  was  much  developed.  In  the  second,  the  head 
was  elevated  at  the  vertex  and  the  nose  flat.  In  the 
third  type  the  parietal  region  was  asymmetrical.  The 
anomalies  of  the  face  were  marked  asymmetry,  sub¬ 
nasal  prognathism,  and  disproportion  of  different  parts. 
There  was  deviation  of  the  nose  and  deep  excavation 
•of  its  root.  The  nose,  being  often  strongly  flattened, 
the  Gothic  palatine  vault  occurred  very  frequently. 
There  was  frequently  complete  division  of  the  palate. 
There  were  teeth  defective,  irregular  in  growth,  riding 
over  each  other  or  widely  separated.  The  teeth  were 
often  notched  and  grooved  (Hutchinson’s  and  Parrot’s 
teeth).  The  teeth  often  encroached  outside  of  the 
dental  arch,  the  parabola  of  which  was  thus  rendered 
irregular.  There  was  atrophy  or  complete  absence  of 
the  superior  lateral  incisor. 


CHAPTER  XVI. 


INTER-OPERATION  OF  CAUSES  AND  PREDISPOSI¬ 
TIONS. 

Q.  How  do  forces  tending  to  changes  in  the  organ¬ 
ism  act? 

A.  It  will  be  seen  that  forces  tending  to  changes  in 
existing  organism,  act  in  various  ways  as  part  of  the 
environment  of  the  individual,  and  through  its  influ¬ 
ence  on  him  produce  changes  in  the  complex  union  of 
checks,  balances,  forces,  and  material  bases  which  con¬ 
stitutes  the  human  organism  as  inherited. 

Q.  What  must  any  unusual  change  in  complex 
unity  be? 

A.  Abnormal,  so  far  as  the  organism  existing  prior 
to  the  change  is  concerned.  The  question  whether 
such  abnormality  be  of  benefit  or  injury  is  another 
matter. 

Q.  Why  is  it  not  necessarily  evil? 

A.  A  metaplasia,  a  change  from  one  species  into 
another,  whether  in  individual  animals  or  plants  or 
individuals  or  their  tissues,  cannot  take  place  without 
anomaly,  for  if  no  anomaly  appear  this  new  departure 
is  impossible. 

Q.  Is  the  physiologic  norm  hitherto  subsisting 
„ changed? 

A.  Yes.  This  change  cannot  well  be  called  any¬ 
thing  but  an  anomaly. 

Q.  What  was  an  anomaly  formerly  called? 

A.  It  was  called  pathos,  and  in  this  sense  every 
departure  from  the  norm  is  a  pathologic  event. 

149 


150 


QUIZ  COMPEND 


Q.  What  must  occur  if  such  pathologic  event  be 
ascertained? 

A.  This  forces  investigation  as  to  what  pathos 
was  the  special  cause  of  it. 

Q.  What  may  this  change  be? 

A.  An  external  force  or  a  chemical  substance  or  a 
physical  agent  producing  in  the  normal  condition  of 
the  body  a  change,  an  anomaly  (pathos). 

O.  What  can  this  become? 

A.  A  foundation  for  certain  slight  hereditary 
characteristics  propagated  in  a  family.  In  themselves 
these  belong  to  pathology,  even  though  they  produce 
no  injury. 

Q.  What  is  disease  in  Greek? 

A.  It  is  nosos,  and  it  is  nosology  that  is  concerned 
with  disease. 

Q.  May  the  pathologic  under  some  circumstances 
be  beneficial? 

A.  It  may  be  of  advantage  to  the  inheritor. 

Q.  What  determines  its  character? 

A.  It  is  obvious  that  the  fact  whether  a  given 
change  in  the  organism  shall  prove  a  defect  or  not  is 
determined  by  the  conditions  of  periods  of  stress  dur¬ 
ing  intra-  and  extra-uterine  life. 

Q.  May  defect  so  affect  the  organism  as  a  whole 
as  to  survive  the  periods  of  stress? 

A.  According  to  general  observations  this  must 
-be  so. 

Q.  What  must  be  taken  into  consideration  in  deal¬ 
ing  with  the  origin  of  any  defect? 

A.  In  dealing  with  the  origin  of  any  defect  or  gain 
in  the  animal  organism,  several  factors  must  be  taken 


A 


151 


ON  IRREGULARITIES  OF  THE  TEETH. 

into  account,  independently  of  the  simple  element  of 
heredity. 

Q.  What  is  an  uncomplicated  agent? 

A.  Heredity,  which  is  usually  regarded  as  produc¬ 
ing  certain  effects. 

Q.  What  must  be  considered  in  dealing  with 
heredity? 

A.  The  influence  of  the  intra-uterine  stress  of  the 
foetus. 

Q.  What  effect  will  unusual  strain  upon  the 
mother  during  gestation  have? 

A.  It  may  produce  an  unfavorable  effect  upon  the 
foetus. 

Q.  Does  a  healthy  ancestry  add  any  weight? 

A.  The  mother  then  would  be  less  liable  to  ill 

% 

effect  from  such  a  strain. 

Q.  What  effects  do  unusually  favorable  conditions 
produce  during  gestation? 

A.  It  may  correct  defects  observable  in  previous 
pregnancies. 

Q.  How  are  periods  of  9tress  constituted? 

A.  By  the  different  periods  of  embryonic  develop¬ 
ment,  as  well  as  by  those  extra-uterine. 

Q.  Can  sex  be  determined  by  condition  of  stress 
after  a  certain  period? 

A.  Yes. 

Q.  What  effect  has  nutrition? 

A.  Poor  maternal  nutrition  will  determine  an 
•excess  of  males,  while  good  will  determine  an  excess 
of  females. 

Q.  What  effect  will  arrest  produce  at  certain 
periods  of  intra-uterine  life? 

A.  It  will  produce  prematurely  senile  states; 


152 


QUIZ  COMPEND 


since,  as  already  stated,-  there  is  a  period  in  intra¬ 
uterine  life  during  which  the  foetus  wavers  between 
the  senile  appearance  of  adult  anthropoid  apes  and 
that  of  mankind  in  youth. 

Q.  What  may  maternal  nerve  exhaustion  do? 

A.  General  nervous  exhaustion  of  the  mother,  first 
affecting  checking  influences  of  the  central  nervous 
system,  finally  leads  to  unchecked  excessive  nervous 
action  of  the  part  of  the  local  nervous  systems  of  the 
organs,  leading  secondarily  to  exhaustion  of  these. 

Q.  What  may  result? 

A.  In  consequence  the  mother  is  unable  to  either 
manufacture  proper  elements  of  nutrition  or  to  ex¬ 
crete  waste  material. 

Q.  What  effect  does  this  have  upon  the  foe-tus? 

A.  The  foetus,  thereby  starved  and  poisoned,  fails 
to  pass  through  the  periods  of  stress  in  a  complete, 
well-balanced  manner. 

O.  On  what  structures  does  stress  bear  the 


strongest? 

A.  Those  which  are  transitory  or  variable  in  type. 

Q.  What  maternal  influence  may  affect  the  foetus? 

A.  Mental  stress  of  the  mother.  The  human 
foetus  exhibits  very  decided  reaction  to  sensory  im¬ 
pressions  on  the  mother. 

Q.  What  occurs  at  these  periods  of  stress? 

A.  The  forces  which  determine  the  variations  of 
the  individual  from  the  race,  and  those  which  tend  to 
preserve  the  race  type,  are  in  constant  conflict. 

Q.  What  determines  whether  or  not  the  foetus 
shall  pass  through  the  complex  embryologic  evolution 
determined  by  the  race  type,  and  whether  or  not  in¬ 
dividual  variations  presented  in  the  parents  shall  be 


ON  IRREGULARITIES  OF  THE  TEETH. 


153 


transmitted  successively  through  these  periods  of 
stress? 

A.  Conditions  affecting  nutrition  of  the  ovum  prior 
to  fecundation  (as  derived  from  the  mother),  and  con¬ 
ditions  affecting  the  fecundation  of  the  ovum  (as 
derived  from  the  father), as  well  as  those  derived  from 
both  father  and  mother  after  fecundation,  will  deter¬ 
mine  whether  or  not  the  foetus  shall  pass  through  the 
complex  embryologic  evolution  determined  by  the 
race  type,  and  whether  or  not  individual  variation 
present  in  the  parents  shall  be  transmitted  through 
these  periods  of  stress. 

Q.  What  local  conditions  enter  greatly  into  these 
factors  qs  regards  the  jaw? 

A.  While  all  the  factors  enumerated  enter  into  jaw 
degeneration,  a  greater  factor  is  extraction  of  the 
temporary  and  permanent  teeth. 

Q.  Is  this  extraction  frequent? 

A.  Yes.  It  is  a  universal  habit  abroad. 

Q.  What  effect  does  it  produce? 

A.  Constant  extraction  of  the  teeth  produces  varia¬ 
tions  (arrests  of  development)  which  are  transmitted 
from  one  generation  to  another.  In  the  evolution  of 
the  jaws,  nothing  could  be  easier  accomplished  than 
this.  One  period  of  stress  is  marked  by  eruption  of 
the  temporary  and  the  next  period  of  stress  by  the 
eruption  of  the  second  set.  The  first  permanent 
molar  is  the  first  tooth  to  erupt  in  the  permanent  set. 
It  is  situated  in  the  center  of  the  jaw.  Permanent 
teeth  erupt  anteriorly  and  posteriorly  to  this  tooth. 
This  tooth,  because  it  is  larger,  requires  more  room. 
The  first  molar  is  the  first  tooth  to  decay.  As  soon  as 
it  aches  it  is  removed.  When  the  other  permanent 


154 


QUIZ  COMPEND 


teeth  erupt  they  move  forward  and  fill  the  space  made 
vacant  by  the  lost  first  molar.  Since  the  jaw  expands 
and  grows  for  the  purpose  of  containing  the  teeth,  in 
their  absence  the  jaw  ceases  to  develop.  What  is  true  of 
the  first  molar  is  also  true  of  the  other  teeth.  In  many 
countries  one  tooth  after  another  is  sacrificed  as  soon 
as  it  begins  to  ache.  Not  infrequently  whole  sets  of 
teeth  are  removed  in  young  life  before  the  jaws  have 
fully  developed.  The  habit  of  early  extraction  of  the 
temporary  and  permanent  teeth  from  one  generation 
to  another  causes  arrest  of  development  in  two 
ways. 

Q.  In  what  two  ways  does  early  extraction  of  the 
temporary  teeth  from  one  generation  to  another  cause 
arrest  of  development? 

A.  First,  through  the  inheritance  of  acquired 
defects;  second,  by  natural  selection.  Since  the  jaws 
and  teeth  are  so  unstable  in  their  development  they 
are  easily  affected. 

Q.  What  influence  has  civilization  on  the  jaws  and 
teeth? 

A.  By  its  economy  as  regards  food  production  and 
preparation  it  has  lessened  markedly  the  function  of 
the  jaws  and  teeth.  Food  no  longer  needs  the  grind¬ 
ing  and  tearing  required  from  primitive  man,  or  even 
from  types  as  high  as  the  “pile  dwellers,”  whose  food 
is  still  to  be  found,  even  to  coarse  breads  and  cakes. 
Under  the  law  of  economy  of  growth,  lessened  mus¬ 
cular  action  leads  to  lessened  blood  supply.  Lessened 
blood  supply  produces  conditions  in  the  offspring 
tending  to  under-nutrition  of  certain  parts  for  the 
benefit  of  the  body  as  a  whole,  and  to  diminish  in  size 
of  unused  parts.  As  the  jaws,  alveolar  process,  and 


ON  IRREGULARITIES  OF  THE  TEETH. 


155 


teeth  are  comparatively  unstable  in  all  mammals, 
these  of  necessity  are  peculiarly  affected  by  disuse. 

Q.  Is  there  a  similar  condition  in  the  lower  ani¬ 
mals? 

A.  The  dog,  to  whom  domestication  plays  the  part 
of  civilization,  has  from  a  carnivore  become  an  omni¬ 
vore.  In  the  mongrel  dogs,  race  admixture  and  other 
factors  producing  change  in  man  are  to  be  found.  In 
the  dog  peculiarly,  does  domestication  play  the  part  of 
civilization.  In  him  jaw  and  tooth  irregularities 
ascribed  to  other  causes  occur.  Facility  for  securing 
food  under  domestication  has  played  a  part.  Disuse 
of  the  jaw  as  a  weapon  by  man  has  done  its  share  in 
the  changes  comparatively  early  in  development. 
To  a  certain  extent  this  last  change  is  still  going  on  in 
the  dog.  In  cases  predisposed  to  advance  in  evolu¬ 
tion,  irregularities  of  beneficial  type  would  occur 
with  great  facility.  In  cases  predisposed  in  the 
opposite  direction,  changes  would  result  of  opposite 
effect. 

Q.  Where  are  the  fewest  contracted  jaws  and 
irregularities  of  the  teeth  found  in  European  count¬ 
ries? 

A.  In  Greece  and  Russia. 

Q.  Where  are  the  greatest  number  found? 

A.  Among  the  English-speaking  people  and  the 
Scandinavians. 

Q.  Why? 

A.  Both  peoples  have  passed  through  very  similar 
phases  of  race  evolution  and  both  contain  at  bottom 
the  same  race  elements. 

Q.  What  is  evident  from  this? 

A.  That  the  struggle  for  existence  between  the 


156 


QUIZ  COMPEND 


organs,  dependent  on  race  evolution  and  race  admix¬ 
ture,  has  in  the  higher  races  resulted  in  the  triumph 
of  the  brain  and  skull  at  the  expense  of  the  face,  hence 
the  higher  the  intellectuality  the  greater  the  tendency 
to  local  anomalies  of  the  face,  jaws,  and  teeth. 


CHAPTER  XVII. 


DEVELOPMENTAL  NEUROSES  OF  THE  FACE. 

Q.  Who  was  the  first  to  study  the  face  in  a  scien¬ 
tific  manner? 

A.  Camper,  whose  results  gave  his  name  to  the 
facial  angle  by  which  is  judged  the  rank  of  the  face. 

Q.  What  is  Camper’s  facial  angle? 

A.  A  line  drawn  from  the  super-orbital  ridge  to  a 
point  at  the  nasal  spine,  and  from  this  point  to  the 
auditory  meatus. 

Q.  What  do  the  facial  angles  of  Camper,  Cuvier, 
Cloquets,  Jacquarts,  the  Munich-Frankfort  angle,  and 
those  of  Topinard  involve? 

A.  Merely  the  bones  of  the  head  and  face. 

Q.  With  what  do  most  authors  deal  in  discussing 
prognathism  and  orthognathism? 

A.  With  the  skull,  including  only  the  superior 
maxilla. 

Q.  What  must  medical  specialists  include? 

A.  The  inferior  maxilla. 

Q.  Why? 

A.  Because  only  by  the  improved  facial  angle  can 
correct  bases  be  obtained  upon  which  to  compare 
deformities  of  the  jaws. 

Q.  Are  there  racial  differences  in  the  facial  angle  at 
the  present  time? 

A.  There  are.  In  the  evolution  of  man  every  race 
may  be  included  at  some  degree  between  the  prog¬ 
nathous  and  orthognathous  type  of  jaw. 

157 


158 


QUIZ  COMPEND 


Q.  Is  there  a  race  type? 

A.  Only  in  a  general  way.  There  may  be  cases  of 
extreme  protrusion  and  recession  of  jaws  in  each 
nationality,  due  to  an  unstable  nervous  system,  a  re¬ 
sult  of  excesses. 

Q.  In  the  countries  of  Europe  how  do  the  jaws 
differ? 

A.  In  most  countries  the  jaws  are  broad  and  pro¬ 
trude,  while  in  some  recession  is  the  rule. 

Q.  In  what  countries  is  orthognathism  most  com¬ 
mon? 

A.  In  Stockholm,  Sweden,  an  examination  of 
5,000  people  showed  the  following  results.  A  perpen¬ 
dicular  line  dropped  from  the  supercilliary  ridge 
showed  only  2  per  cent,  outside,  14.70  per  cent,  on 
the  line  and  83.00  inside  the  line  or  orthognathous. 
In  London  an  examination  of  10,000  revealed  4.13  per 
cent,  outside  the  line,  12.87  on  the  line  and  83.00 
inside  the  line.  In  an  examination  of  3,000  English 
school  children  (about  ten  years  of  age)  93  per  cent, 
possessed  jaws  inside  of  the  line.  Prognathism  as  a 
rule  was  a  prominent  feature  in  other  nationalities. 

Q.  What  significance  has  this? 

A.  In  a  general  way  it  is  possible  to  decide,  with¬ 
out  an  examination  of  the  mouth,  the  frequency  of 
irregularities  of  the  teeth;  when  prognathism  is 
present  there  is  plenty  of  room  for  the  teeth,  and  vice 
versa. 

Q.  Is  there  not  a  quicker  and  easier  way  to  arrive 
at  this  result? 

A.  There  is?  The  evolution  of  the  American 
negro  is  an  apt  and  striking  illustration. 

Q.  Give  examples. 


ON  IRREGULARITIES  OF  THE  TEETH. 


159 


A.  Dr.  W.  E.  Walker  made  an  examination  of  357 
of  the  lowest  negro  type  in  New  Orleans.  His  results 
were  protrusion  in  97.5  per  cent.,  on  the  line  2.5. 
Those  made  in  Baltimore  show  8  per  cent,  outside 
the  line,  36. 5  on  the  line,  55.5  inside.  Those  made 
in  Philadelphia,  686  in  all,  83.57  outside,  15.95  on  the 
line, and  1.13  inside.  In  Boston,  of  1,000,  45.5  outside 
the  line,  39.5  on  the  line,  15. 1  receding.  In  Chicago, 
of  1,085,  51.06  presented  protrusion,  31.08  on  the  line, 
and  16.6  inside  the  line.  It  will  be  seen,  therefore, 
although  the  negro  is  from  a  marked  dolichocephalic 
race  with  excessively  protruding  jaws,  climate,  soil, 
and  intermixture  have  made  a  wonderful  change  in 
a  very  few  years. 

Q.  How  does  the  change  in  the  jaws  compare  with 
that  of  the  teeth? 

A.  Evolution  of  the  teeth  is  a  much  slower  process. 
The  teeth  do  not  grow  smaller  in  proportion  to  the 
jaws. 

Q.  How  does  the  evolution  of  the  jaws  compare 
with  the  weight? 

A.  In  the  same  proportion.  Ward  has  shown  by 
weight  that  absolute  size  of  the  lower  jaw  is  greater  in 
primitive  races.  Of  nine  aborigines  the  mean  weight  of 
the  jaw  was  102.4  grams.  Of  eighteen  white  males  the 
mean  weight  of  the  jaw  was  only  83. 4  grams.  Yet 
the  weight  of  the  skull  was  nearly  alike  in  both  cases. 

Q.  What  is  the  weight  of  the  lower  jaw  compared 
with  that  of  the  cranium? 

A.  It  is  15.6  from  aboriginal  man  as  against  12.16 
from  white  men.  It  is  46.2  from  anthropoid  apes. 

Q.  What  does  this  prove? 

A.  It  proves  a  progressive  degeneracy  in  the  jaws. 

13 


160 


QUIZ  COMPEND 


Q.  Are  changes  taking  place  in  the  shape  of  the 
head? 

A.  Yes.  An  examination  of  eighteen  negroes  taken 
at  random  revealed  five  with  a  cephalic  index  below 
seventy,  six  between  seventy  and  eighty,  and  seven 
about  eighty.  In  an  examination  of  2,000  negroes 
in  Chicago  only  six  dolichocephales  were  found. 

Q.  What  do  these  figures  indicate? 

A.  They  show  that,  allowing  for  slight  admixture 
of  brachycephaly  from  the  negro  race  themselves, 
change  in  climate  and  admixture  of  Indian  and  Cau- 
casic  races  in  America  have  completely  changed  the 
shape  and  physique  of  the  negro. 

Q.  What  characteristic  feature  has  a  tendency  to 
increase  prognathism? 

A.  The  excessive  development  of  the  inferior 
maxilla.  The  rami  and  body  of  the  lower  jaws, 
together  with  the  muscles  of  mastication,  are  very 
large  and  massive  as  compared  with  those  of  the 
white.  The  constant  force  of  the  larger  lower  jaw 
against  the  light  upper  causes  the  teeth  and  alveolar 
process  to  be  carried  forward,  producing  prognathism.. 

Q.  How  do  the  jaws  of  the  negroes  living  in  the 
Northern  states  compare  with  those  of  the  whites? 

A.  Their  jaws  are  not  unlike  those  of  the  Caucasic 
races.  The  zygomatic  arches  are  smaller.  The 
muscles  are  less  dense  and  rigid,  the  lower  jaws  less 
massive,  and  orthognathism  in  lieu  of  prognathism 
occurs  to  a  certain  extent. 

Q,  What  do  degeneracies  imply? 

A.  Deficiencies  in  constitution,  not  only  mental  and 
moral,  but  neurosal  and  structural. 

Q.  How  do  these  deficiencies  manifest  themselves? 


ON  IRREGULARITIES  OF  THE  TEETH. 


161 


A.  By  expression  of  imperfect  advance,  evincing 
itself  in  the  unequal  balance  between  hypertrophy, 
excessive  development,  statu  quo ,  and  atrophy. 

Q.  Which  structures  of  the  body  are  more  liable 
to  become  affected  than  others? 

A.  Transitory  structures. 

Q.  Name  some  of  them. 

A.  The  vermiform  appendix,  the  ears,  the  head, 
face,  jaws,  and  teeth. 


CHAPTER  XVIII. 


DEVELOPMENTAL  NEUROSES  OF  THE  NOSE  AND 
INTERIOR  FACIAL  BONES. 

Q.  Does  the  embryonic  development  of  the  bones 
of  the  nose  and  internal  facial  bones  differ  from  that 
of  other  structures  of  the  head  and  face? 

A.  No,  The  interior  bones  of  the  face  are  as  tran¬ 
sitory  in  their  nature  and  development  as  the  jaws  and 
teeth. 

O.  Are  deformities  of  the  vomer,  turbinated  bones, 
and  the  maxillary  sinuses  associated  with  other  de¬ 
formities  of  the  face  and  jaws? 

A.  Nearly  always.  Deformities  of  the  internal 
bones  of  the  face  may  occur,  however,  without  face  and 
■  jaw  deformities,  and  vice  versa. 

Q.  What  is  the  frequency  of  vomer  deformities? 

A.  Theile  found  the  septum  normally  placed  in 
twenty-nine  out  of  117  skulls.  Semeleder  examined 
forty-nine  skulls  and  found  deflection  to  the  left  in 
twenty,  to  the  right  in  fifteen,  and  sigmoid  deformity 
in  four.  Harrison  Allen  in  fifty-eight  skulls  found 
narrowing  to  the  left  nineteen,  to  the  right  twenty- 
one. 

Q.  Are  dry  skulls  available  according  to  Zucker- 
kandl? 

A.  Dry  skulls  do  not  accurately  illustrate  the  con¬ 
dition  of  the  septum. 

Q.  What  were  Zuckerkandl's  results  from  re¬ 
searches  on  the  cadaver? 


163 


164 


QUIZ  COMPEND 


A.  Out  of  370  he  found  123  symmetrical  and  140 
asymmetrical.  In  the  deformed  specimens  the 
septum  was  inclined  to  the  right  in  fifty-seven  cases, 
to  the  left  in  fifty-one,  sigmoid  in  thirty-two. 

Q.  What  results  had  Mackenzie? 

A.  He  examined  2,152  skulls  in  the  museum  of  the 
Royal  College  of  Surgeons,  London,  He  found  1,657 
deformed  septa,  834  deflected  to  the  left,  609  to  the 
right.  In  205  the  deflection  was  sigmoid,  while  in 
five  the  irregularity  was  zigzag,  showing  70  per 
cent,  of  deformities  in  the  dry  skulls,  and  only  40 
in  the  cadaver. 

Q.  What  did  Heyman’s  examination  show? 

A.  Ninety-nine  per  cent,  of  deformities  in  living 

subjects. 

Q.  How  do  these  compare  as  regards  races? 

A.  Zuckerkandl  found  in  103  cases  of  primitive 
and  semi-primitive  races  twenty-four  were  asymmet¬ 
rical.  Mackenzie  in  430  skulls  of  superior  races  22.0 
per  cent,  of  deformities.  He  confirms  the  observa¬ 
tions  of  Zuckerkandl. 

Q.  What  are  Harrison  Allen’s  observations? 

A.  He  found  in  ninety-three  negro  skulls  deform¬ 
ities  of  the  septum  in  21.5  per  cent. 

Q.  What  are  the  results  of  Talbot’s  researches? 

A.  He  examined  11,000  skulls  in  this  country  and 
Europe,  including  the  collection  in  the  museum  of 
the  Royal  College  of  Surgeons,  and  347  living  individ¬ 
uals.  He  confirms  the  report  of  Mackenzie.  Owing 
to  the  fragility  of  the  septum  the  whole  or  anterior 
part  was  lost  in  3,400  skulls.  Of  the  7,600  skulls, 
5,762  showed  marked  deformities.  Out  of  687  ancient 
Peruvian  skulls,  147  possessed  deflection  of  the  sep- 


ON  IRREGULARITIES  OF  THE  TEETH. 


165 


turn.  In  sixty-nine  Stone  Grave  Indians  thirty-five 
were  normal,  thirty-four  deformed.  In  eighteen 
Mound  Builders,  eight  were  normal  and  ten  deformed. 
In  six  California  Indians  four  were  normal.  In 
twenty-eight  skulls  of  ancient  Hawaiians  deflection  of 
the  septum  was  noticed  in  twenty-three  cases. 

Q.  Were  other  deformities  noticed  in  Hawaiian 
skulls? 

A.  Yes.  In  two  cases  where  the  inferior  turbinate 
bones  were  undeveloped  the  septum  deflected  to  that 
side.  There  were  projections  which  seemed  to  take 
the  place  of  the  missing  turbinates. 

Q.  What  was  the  condition  of  the  vomer  in  living 
persons? 

A.  One  hundred  and  seven  showed  deflection  of  the 
septum. 

Q.  Does  Zuckerkandl’s  theory  that  dried  specimens 
are  unsatisfactory  in  studying  deformities  of  the  sep¬ 
tum  hold  true? 

A.  It  does  not  seem  plausible,  for  the  reason  that 
the  two  points  of  attachment  are  fixed  at  puberty. 
The  septum,  green  or  dry,  cannot  change  its  position ;  in 
the  dry  the  deformity  may  not  be  quite  as  marked. 

Q.  Is  not  deflection  of  the  septum  in  the  living 
subject  or  the  cadaver  more  difficult  to  diagnose  than 
in  the  dry  skull? 

A.  Certainly.  This  no  doubt  accounts  for  the 
small  percentages  of  deformities  reported  by  Zucker- 
kandl  and  Talbot. 

Q.  Are  there  not  deflections  in  the  posterior  nares 
that  are  difficult  to  discover? 

A.  Yes.  Deflections  in  the  middle  and  posterior 
nares  are  quite  difficult  to  detect. 


166 


QUIZ  COMPEND 


Q.  What  shapes  do  these  deformities  usually  take? 

A.  The  sigmoid  (S-shaped),  again  like  the  letter 
C,  and  often  like  the  small  italic  letter /  The  fact 
that  it  is  attached  throughout  at  its  upper  and  lower 
border  to  a  solid  framework,  its  middle  portion  is 
liable  to  bend  in  any  direction  like  a  loose  sail  in  the 
wind. 

Q.  May  septum  fracture  be  easily  differentiated 
from  deflection? 

A.  Yes. 

Q.  What  are  some  of  the  theories  as  to  the  cause 
of  deformities? 

A.  The  use  of  astringents  was  one  of  the  older 
theories.  Morgagni’s  was  that  they  were  due  to 
excessive  development  of  the  vomer.  Trendelenburg 
believed  they  were  due  to  crowding  up  of  a  high 
arched  palate,  since  the  two  conditions  are  frequently 
connected.  Jarvis  having  seen  four  cases  in  the  same 
family  believed  it  due  to  direct  heredity.  Schaus  and 
Walker  believed  it  due  to  faulty  development  of 
the  facial  skeleton.  Bosworth  believed  it  due  to 
traumatism. 

Q.  Is  it  possible 'for  traumatism  and  low  forms  of 
inflammation  to  produce  all,  or  nearly  all,  of  these 
deformities? 

A.  It  does  not  seem  possible.  If,  however,  by 
traumatism  is  meant  inhalation  of  air,  this  would 
account  for  fracture. 

Q.  What  proportion  of  those  examined  seem  to  be 
fractures? 

A.  Of  the  entire  number  examined,  2,684  appeared 
to  be  fractures. 

Q.  Where  were  these  fractures  located? 


ON  IRREGULARITIES  OF  THE  TEETH. 


167 


A.  Most  were  at  the  middle,  while  some  were  at  the 
posterior  part  to  the  vomer.  This  fracture  or  rough¬ 
ening  was  always  in  the  convex  surface  of  the  bend. 

Q.  How  was  this  repaired? 

A.  Frequently  ribs  of  bone  would  be  thrown  out 
to  support  this  curvature. 

Q.  Could  a  blow  reach  the  point? 

A.  No.  Most  of  them  were  located  from  .75  to 
two  inches  inside  the  nose  from  the  nasal  spine. 

Q.  Does  the  inflammatory  theory  seem  logical? 

A.  No.  The  inflammatory  condition  must  extend 
iipon  both  sides,  since  the  bone  (should  one  be  present) 
is  very  thin. 

Q.  How  about  a  high,  contracted  vault  forcing  the 
septum  out  of  place? 

A.  While  high  vaults  and  deflected  septums  most 
always  go  hand  in  hand,  it  is  impossible  for  the  vault 
to  be  carried  upwards  owing  to  the  strong  support  of 
the  nasal  bone.  The  vault  is  developed  downwards, 
not  upwards. 

Q.  Would  not  the  suture  assist  in  preventing  the 
vault  being  carried  up? 

A.  Most  certainly.  The  suture  at  the  median  line 
is  like  the  keel  of  a  ship,  only  upside  down. 

Q.  At  what  period  does  the  vault  obtain  its  shape? 

A.  Not  until  after  the  sixth  year.  The  high  vault 
is  never  seen  before  that  time,  since  it  forms  with  the 
second  set  of  teeth. 

Q.  Are  deflected  septa  found  at  that  period? 

A.  A  large  majority  of  cases  are  found  to  com¬ 
mence  to  form  before  that  time. 

Q.  Could  the  vomer  pull  up  or  push  down  the 
vault? 


168 


QUIZ  COMPEND 


A.  No.  In  either  case  the  vomer  would  become 
taut. 

Q.  It  has  been  claimed  the  ridge  frequently  found 
in  the  roof  of  the  mouth  is  due  to  the  downward 
movement  of  the  vomer. 

A.  In  an  examination  of  1,367  skulls  in  which  this 
was  partially  or  fully  developed,  a  corresponding 
depression  could  not  be  found  in  the  floor  of  the  nose. 

Q.  What  is  the  relation  between  deflected  septa  and 
high  vaults? 

A.  All  who  have  made  investigation  have  shown 
that  deflected  septa  are  common  among  early  and 
relatively  pure  races.  High  vaults  and  contracted 
arches  are  never  seen  in  such  people. 

Q.  What  is  the  most  plausible  theory? 

A.  That  advanced  by  Morgagni,  that  the  septum 
has  developed  beyond  normal,  and  in  order  to  accom¬ 
modate  itself  it  must  deflect  to  the  right  and  left. 

Q.  Would  not  obstruction  to  the  nose  assist  in 
developing  the  vomer? 

A.  Yes.  The  inhalation  of  air  would  cause  a 
vacuum,  drawing  the  bone  in  and  causing  it  to  develop 
in  either  direction. 

Q.  Are  not  the  turbinated  bones  often  either  ex¬ 
cessively  developed  or  arrested? 

A.  Yes.  The  inferior  turbinates  are  rarely  if  ever 
normal.  Sometimes  they  are  so  large  as  to  fill  the 
lower  part  of  the  nose,  again  they  are  not  developed. 
Again  one  side  will  be  hypertrophied,  the  other 
arrested. 

Q.  When  asymmetry  of  the  skull  and  face  are 
observed  are  stigmata  apt  to  be  found  in  the  nasal 
bone? 


ON  IRREGULARITIES  OF  THE  TEETH.  169 

A.  Yes.  Almost  invariably.  The  two  sides  of  the 
face  are  unlike,  one  orbit  may  be  smaller  than  the 
other  and  one  maxillary  bone  contain  a  smaller 
antrum  than  the  other  side. 

Q.  Will  arrest  of  development  of  one  side  cause  the 
teeth  to  be  forced  out  of  the  arch? 

A.  Yes,  and  the  roots  of  the  teeth  in  many  cases 
protrude  through  the  outer  plate  of  the  alveolar  pro¬ 
cess. 

Q.  Are  the  mastoid  processes  involved? 

A.  One  or  both  may  be  excessively  developed  or 
arrested. 

Q.  When  the  turbinated  bones  are  excessively 
developed  or  arrested,  what  position  does  the  vomer 
assume? 

A.  It  usually  takes  the  curve  of  the  turbinates  so 
that  it  will  stand  about  midway  in  all  directions. 

Q.  Are  the  nasal  cavities  often  arrested? 

A.  The  nasal  cavities  are  sometimes  arrested 
with  hypertrophy  of  the  turbinates,  deflection  of  the 
septum,  and  hypertrophy  of  the  mucous  membrane, 
preventing  the  child  from  breathing  through  the  nose. 

Q.  Does  not  arrest  of  the  nasal  cavities  mean 
arrest  of  the  superior  maxilla  and  vice  versa? 

A.  When  one  is  involved  the  other  is  also  apt 
to  be. 

Q.  Is  it  common  to  find  arrest  of  development  of 
the  inferior  turbinate  bone  in  ancient  skulls? 

A.  Yes.  It  is  quite  common  in  Alaskan  races  and 
Peruvian  skulls. 

Q.  What  other  stigmata  may  be  seen  in  connection 
with  the  nasal  cavities? 

A.  Occasionally  one  nasal  cavity  will  be  lower  than 


170 


QUIZ  COMPEND, 


the  other,  again  both  cavities  may  be  carried  over  to 
one  side. 

Q.  With  such  deformities  of  the  bones  of  the  nose 
and  maxilla,  there  must  be  marked  deformities  in  the 
antra. 

A.  Such  is  the  case.  Sometimes  the  internal  bones 
of  the  face  will  be  deformed  to  the  extent  that  a  very 
large  antrum  will  develop  upon  one  side  and  none 
upon  the  other.  Again,  one  side  will  be  made  up  of 
eight  or  more  small  cavities  like  the  ethmoidal  cells, 
while  the  antrum  upon  the  other  side  will  be  large. 

Q.  Does  this  make  it  difficult  to  enter  the  antrum 
by  carrying  a  drill  up  through  the  alveoli? 

A  This  is  very  unsafe  procedure.  Operators  have 
often  carried  the  drill  into  the  floor  of  the  nose. 

Q.  Are  projections  or  spurs  often  found  in  the 
nose? 

A.  They  are  very  common.  They  may  be  situated 
at  almost  any  locality,  but  seem  to  be  found  at  any 
point  where  there  is  considerable  space. 

Q.  What  is  the  most  common  location  for  them? 

A.  Upon  the  vomer,  projecting  midway  between 
the  turbinated  bones. 

Q.  What  is  the  width  of  the  external  nasal  cavity? 

A.  It  varies  greatly.  In  2,000  skulls  the  greatest 
width  was  1.25  inches,  the  smallest  was  .75.  The 
length  from  the  nasal  spine  to  the  outer  border,  greatest 
width  1.54,  smallest  1.20.  These  skulls,  however,  were 
those  of  Peruvian  Stone  Grave  Indians,  Mound 
Builders,  Cliff-Dwellers,  Hawaiians,  etc.  In  neuroties 
and  degenerates,  where  arrest  of  development  of  the 
face  and  nose  takes  place,  the  width  measured  .50  to 
.60  inches,  .80  to  .90  of  an  inch  in  length. 


ON  IRREGULARITIES  OF  THE  TEETH. 


171 


Q.  If  both  sides  be  not  alike,  will  there  be  free 
circulation? 

A.  No.  If  one  side  is  filled  with  excessively  devel¬ 
oped  bones,  the  other  side  will  have  to  take  air  enough 
to  supply  the  required  amount.  This  will  cause  the 
open  side  to  enlarge. 

Q.  What  were  Ziem’s  experiments? 

A.  He  showed  that  if  one  nostril  of  a  rabbit  be  per¬ 
manently  closed,  and  the  animal  killed,  when  it  had 
attained  its  full  growth,  the  nasal  cavity  of  the  affected 
side  will  be  found  to  be  undeveloped,  and  face  asym¬ 
metry  occur. 

Q.  What  was  the  condition  of  the  opposite  side? 

A.  The  air  passages  in  the  opposite  side  were  en¬ 
larged. 

Q.  What  effect  does  a  greater  quantity  of  air  have 
upon  the  developed  side? 

A.  The  turbinates  enlarge,  owing  to  the  stimula¬ 
tion,  and  the  vomer  is  carried  to  the  weaker  side. 

Q.  Does  the  septum  ossify  as  early  as  the  other 
bones  of  the  nose? 

A.  It  does  not,  and  therefore  it  is  more  easily 
moved  out  of  normal  position. 

Q.  At  what  period  does  this  occur? 

A.  At  or  about  the  sixth  year. 

Q.  Are  these  bones  vascular? 

A.  They  are. 

Q.  For  what  reason? 

A.  For  the  purpose  of  warming  the  air  before  it  is 
taken  into  the  lungs. 

Q.  Owing  to  this  vascularity  are  they  more  liable 
to  excessive  development? 

A.  They  are.  The  turbinates  being  exceedingly 


172 


QUIZ  COMPEND. 


unstable,  with  considerable  vascularity,  the  slightest 
stimulation  causes  them  to  develop. 

Q.  Does  the  condition  of  the  turbinates  determine 
the  future  shape  of  the  vomer? 

A.  Yes.  These  develop  first  and  the  vomer  ossify¬ 
ing  last  is  molded  into  position  by  inhalation  and  exhal¬ 
ation  of  air  as  nearly  as  possible  into  two  equal  cavities. 

Q.  Are  both  sides  always  equal? 

A.  Not  always;  owing  to  inflammation  of  the 
mucous  membrane  of  one  or  both  sides,  due  to  colds 
and  other  causes,  one  side  will  become  filled  up.  This 
not  infrequently  causes  the  vomer  to  become  attached 
to  the  turbinates. 

Q.  In  what  class  of  patients  do  these  conditions 
usually  occur? 

A.  In  neurotics  and  degenerates,  since  tissue  build  ¬ 
ing  is  very  unstable. 

Q.  Is  it  in  them  that  atrophy,  hypertrophy,  and 
adenoid  growths  usually  occur? 

A.  Yes.  Arrest  of  development  of  the  face,  includ¬ 
ing  the  upper  jaw  and  bones  of  the  nose,  first  takes 
place,  the  nose  fills  up  on  account  of  the  arrest,  and 
hypertrophy  of  the  bones  of  the  nose  results,  filling 
the  nasal  cavities,  the  result  of  which  mouth-breathing 
takes  place. 

Q.  Is  nasal  catarrh  associated  with  such  cases? 

A.  It  almost  always  occurs  in  such  unstable  condi¬ 
tions. 

Q.  What  is  the  general  appearance  of  the  nose? 

A.  In  neurotics  and  degenerates  the  face  is  arrested 
from  the  supercilliary  ridges  down  to  and  including 
the  teeth  of  the  upper  jaw.  It  has  a  hollowed-out 
appearance.  The  nose  is  long  and  thin. 


ON  IRREGULARITIES  OF  THE  TEETH. 


173 


Q.  Does  inhalation  interfere  in  such  cases? 

A.  Very  markedly.  When  the  person  inhales  air 
the  sides  of  the  nose  close  like  a  bellows,  causing  the 
person  to  breath  through  the  mouth. 

Q.  What  peculiar  characteristic  is  nearly  always 
noticed  in  persons  who  possess  arrest  of  the  nose  and 
face? 

A.  Arrest  of  chest  walls  and  lung  tissue  almost 
always  takes  place. 

Q.  What  significance  has  this? 

A.  Such  people  are  liable  to  become  infected  with 
tubercle  bacilli, because  of  mouth-breathing;  the  germs 
are  taken  into  the  mouth  and  are  easily  passed  into 
the  undeveloped  lungs. 

Q.  What  precaution  should  be  taken  in  such 
children? 

A.  Children  who  have  arrest  of  nose,  face,  jaws 
and  chest  walls  should  live  out  of  doors  as  much  as 
possible,  eat  nutritious  food,  and  have  the  best  of 
hygienic  attention. 

Q.  What  is  the  antrum? 

A.  It  is  a  cavity  situated  upon  either  side  in  the 
superior  maxillary  bone. 

'  Q.  Describe  it. 

A.  Gray  speaks  of  it  as  being  a  large  triangular¬ 
shaped  cavity;  its  apex,  directed  outward,  is  formed  by 
the  malar  process;  its  base  by  the  outer  wall  of  the 
nose.  This  description  does  not  hold  good  in  all  cases, 
since  the  antrum  (which  depends  on  variation  in  evo¬ 
lution  of  the  face,  and  further  variation  dependent  on 
the  nature  of  the  transitory  structure  with  which  it  is 
connected,  as  well  as  on  the  periods  of  evolutionary 
stress)  must  be  entirely  variable.  It  is  hence  not 


174 


QUIZ  COMPEND 


surprising  that  the  variability  of  the  antrum  cannot  be 
overestimated. 

Q.  What  maybe  said  of  it  in  a  general  way? 

A.  That  the  height,  length,  width,  and  location  are 
governed  by  the  shape  of  the  face,  and  by  the  type  of 
the  nose,  and  of  the  superior  maxilla.  The  shape  and 
position,  therefore,  vary  widely. 

O.  Describe  some  of  these. 

A.  One  may  be  very  small  and  resemble  a  crescent 
with  the  concavity  toward  the  nasal  wall,  its  convexity 
toward  the  malar  process.  It  may  not  be  large  enough 
to  admit  the  end  of  the  little  finger,  and  may  not 
extend  laterally  to  the  inferior  orbital  opening. 
Sometimes  the  antrum  upon  one  side  will  be  very 
long,  while  upon  the  other  it  is  very  short  and  small. 
Usually  the  nasal  cavity  will  be  carried  over  nearly 
one-half  its  size  to  the  side  of  the  smallest  antrum. 

Q.  Is  it  not  sometimes  almost  obliterated? 

A.  Occasionally  the  locality  of  the  antrum  will  be 
filled  with  soft  cancellated  bone,  again  it  will  be 
divided  into  small  cavities,  with  cancellated  bone 
between  them.  These  resemble  the  ethmoidal  cells. 

Q.  In  most  cases  what  shape  does  the  antrum 
assume? 

A.  Although  the  antrum  is  usually  regarded  as  a 
triangle,  it  assumes  even  in  normal  subjects  a  great 
variety  of  shapes.  In  degenerates,  therefore,  a 
greater  variety  of  shapes  and  positions  are  assumed. 

Q.  Should  great  care  be  exercised  in  making  open¬ 
ings  into  the  antrum  in  operations? 

A.  Yes.  The  cavity  is  sometimes  situated  entirely 
outside  of  the  alveolar  ridge.  In  such  cases  the  floor 
of  the  nose  is  usually  over  the  alveolar  process.  A 


ON  IRREGULARITIES  OF  THE  TEETH. 


175 


drill  passing  through  the  alveolar  process  would  enter 
the  floor  of  the  nose.  In  some  cases  the  antrum  is  so 
large  that  it  extends  from  about  midway  the  face, 
including  the  inner  surface  of  the  malar  process,  with 
a  very  thin  wall  for  the  floor  of  the  orbit.  In  drilling 
an  opening  through  the  alveolar  process  care  should 
be  exercised  not  to  allow  it  to  pass  through  the  floor 
into  the  orbital  cavity. 

Q.  Is  it  not  possible  for  the  antrum  to  become 
obliterated  with  such  malformations? 

A.  When  the  cavity  is  extremely  large  upon  one 
side  the  chances  are  that  it  is  very  small,  or  nearly  or 
quite  obliterated,  in  the  other  side.  In  such  cases  a 
drill  would  not  reach  it  when  passed  through  the 
alveolar  process. 

Q.  In  these  cases  was  the  antrum  clear  and  free  of 
all  obstruction? 

A.  In  963  cases  septal  projections  were  found  rang¬ 
ing  all  the  way  from  simple  ridges  to  partitions  extend¬ 
ing  two-thirds  the  height  of  the  cavity;  again  several 
septa  or  partitions  could  be  seen  dividing  the  cavity 
into  many  smaller  ones. 

Q.  Did  they  completely  separate  the  cavity? 

A.  In  no  case  was^he  cavity  entirely  separated. 

Q.  Do  the  roots  of  the  teeth  ever  penetrate  the 
antrum? 

A.  In  an  examination  of  11,000  skulls,  3,000  were 
broken  so  that  the  antra  could  be  examined,  making 
6,000  antra  in  all.  Of  this  number  1,274,  or  .about 
twenty-one  per  cent.,  had  abscessed  teeth ;  of  this  num¬ 
ber  seventy-six,  or  about  six  per  cent.,  extended  into 
and  discharged  into  the  antrum.  Dr.  M.  H.  Fletcher, 
of  Cincinnati,  examined  500  skulls,  making  1,000 


176 


QUIZ  G@MPEN© 


antra,  with  the  fallowing  results:  Two  hundred  and 
fifty-two  upper  molars  were  abscessed,  making  twenty- 
five  per  cent,  in  the  locality  of  the  antrum.  In  these, 
abscesses  in  the  antrum  were  found  twelve  times,  or 
one  in  every  twenty-one. 

Q.  Are  many  cases  of  diseased  antrum  due  to 
abscessed  teeth  found? 

A.  In  a  thirty  years’  practice,  367  cases  of  pulpless 
molars  (less  than  one  per  cent.)  were  found.  In  224 
cases  of  pulpless  molars,  Dr.  M.  H.  Fletcher  found 
only  one  case  of  pus  in  the  antrum.  Dr.  Bonwill  had 
never  seen  a  case  in  his  practice.  Antral  disease  is 
very  rarely  the  result  of  abscessed  teeth. 


I 


I 


CHAPTER  XIX. 


DEVELOPMENTAL  NEUROSES  OF  THE  EYE. 

Q.  Are  the  eyes  in  the  embryo  larger  than  in  the 
adult? 

A.  They  are.  They  resemble  the  eyes  of  the 
lemurs,  thus  retaining  an  embryonic  tendency. 

Q.  Are  the  large  orbits  liable  to  remain? 

A.  Embryonic  large  sockets  may  remain,  or  they 
may  pass  through  the  lemurian  stage,  to  reach  and 
even  exceed  the  anthropoidia  in  smallness  and  close¬ 
ness  together. 

Q.  Do  the  eyes,  like  other  structures,  embryon- 
ically  pass  through  the  different  zoologic  phases? 

A.  The  eyes,  like  the  brain  and  other  structures  of 
the  body,  pass  through  the  different  vertebrate  stages 
of  development. 

Q.  What  causes  these  changes? 

A.  If  growth  be  interfered  with  by  the  law  of  econ¬ 
omy  of  growth,  the  eye  assumes  lower  forms,  as  in 
persistent  hyaloid,  colobomata,  microphthalmia,  etc. 

Q.  Do  these  structures  resemble  exactly  those  of 
the  lower  animals? 

A.  Neither  the  degenerate  human  brain  nor  the 
undeveloped  eye  resemble  exactly  the  brain  or  eye  of 
the  lower  animals. 

Q.  What  are  the  views  as  to  the  primitive  eye  type 
of  the  vertebrates? 

A.  There  are  two  claims,  one  that  the  eyes  were 
derived  from  the  median  eye  of  the  ascidian  lancelet, 

177 


178 


QUIZ  COMPEND 


the  other  that  existing  vertebrate  eyes  represent  the 
paired  eyes  of  a  hypothetic  annelid  precursor.  Both 
views  are  reconcilable  through  study  of  the  ascidian 
and  lancelet  eye  collated  with  cyclopian  and  trioph- 
thalmic  (three-eyed)  degeneracies  in  man,  the  human 
eye  and  the  third  eye  of  reptiles,  like  the  hatteria  of 
New  Zealand. 

Q.  Does  the  eye  of  the  ascidian  tadpole  agree  fun¬ 
damentally  with  the  type  of  eye  peculiar  to  the  verte¬ 
brates? 

A.  Yes,  in  that  the  retina  is  derived  from  the 
wall  of  the  brain.  On  this  account  it  is  called  a  myo- 
lonic  eye. 

Q.  How  doe§  the  typical  invertebrate  eye  differ? 

A.  The  retinal  cells  are  differentiated  from  the 
external  ectoderm. 

Q.  How  does  the  ascidian  eye  differ  essentially 
from  the  paired  eyes  of  the  skulled  vertebrates? 

A.  In  that  the  lens,  as  well  as  the  retina,  is  derived 
from  the  wall  of  the  brain. 

Q.  How  is  the  lens  of  the  lateral  eye  of  the  verte¬ 
brates  derived? 

A.  From  an  invagination  of  the  ectoderm,  which 
meets  and  fits  in  the  retinal  cup  of  the  end  of  the 
optic  vesicle. 

Q.  How  does  the  ascidian  eye,  as  to  lens  origin, 
agree  with  the  parietal  or  pineal  eye  of  the  lizard? 

A.  The  lens  is  likewise  derived  from  cells  which 
form  part  of  the  wall  of  the  cerebral  outgrowth  that 
gives  rise  to  the  pineal  body. 

Q.  What  is  the  pineal  body? 

A.  It  is  a  remarkable  rudimentary  structure,  whose 
constant  presence  in  all  groups  of  vertebrates  forms 


ON  IRREGULARITIES  OF  THE  TEETH. 


179 


such  an  eminently  characteristic  median  outgrowth 
from  the  dorsal  wall  of  the  brain  (thalamencephalon). 
The  distal  extremity  of  this  dilates  into  a  vesicle  and 
becomes  separated  from  the  proximal  portion. 

Q.  What  becomes  of  the  distal  vesicle? 

A.  It  becomes  entirely  constricted  off  from  the 
primary  epiphysial  (pineal)  outgrowth  of  the  brain, 
and  the  parietal  nerve  does  not  represent  the  primitive 
connection  of  the  pineal  eye  with  the  roof  of  the  brain, 
but  arises  quite  independently  of  the  proximal  portion 
of  the  epiphysis. 

Q.  What  did  the  remote  ancestors  of  the  verte¬ 
brates  possess? 

A.  A  median  unpaired  myolonic  eye,  which  was 
subsequently  replaced  in  functon  by  the  evolution  of 
the  paired  eyes. 

Q.  Do  cyclopic  conditions  occur  frequently? 

A.  Yes.  More  frequently  among  human  mon¬ 
strosities  than  among  animals. 

Q.  Why? 

A.  This  is  due  to  the  fact  that  human  monstrosities 
are  much  more  frequently  recorded.  Of  the  120  cases 
of  human  cyclopia  fifty-six  presented  other  evidences 
of  degeneracy  than  cyclopic  conditions,  and  sixty  had 
neuropathies  or  other  taint  in  the  ancestry. 

Q.  How  is  a  cyclops  produced? 

A.  Production  of  a  single  eye,  the  changes  in  the 
structure  of  the  mouth,  the  strophy  and  abnormal 
situation  of  the  olfactory  apparatus  and  of  the  vesicle 
of  the  hemispheres,  all  result  from  arrest  of  develop¬ 
ment,  as  Dareste  has  shown.  The  determining  influ¬ 
ences  must  be  exerted  very  early  in  the  life  history  of 
the  embryo. 


180 


QUIZ  COMPEND 


Q.  Cite  instances  of  cyclops. 

A.  A  female,  born  alive,  to  a  negro  muitipara, 
which  died  two  hours  after  birth.  The  eye  was  cen¬ 
trally  located  in  the  forehead  on  a  line  with  the  nose. 
The  brow  was  a  complete  arch,  as  was  the  upper 
eyelid.  The  lower  lid  had  a  mark  midway,  indicating 
an  attempt  at  division.  The  nasal  bones  were  want¬ 
ing.  The  soft  part  of  the  nose,  destitute  of  the  orifice, 
hung  over  the  mouth,  which  was  completely  covered. 
The  chin  was  recedent.  In  another  case  the  nose  was 
wanting.  Its  place  in  the  median  line  was  occupied 
by  a  single  eye;  on  the  horizontal  diameter  were  two 
pupils  separated  by  a  narrow  space. 

‘Q.  What  does  Landolt  claim? 

A.  Discussing  a  case  by  Valude,  he  claims  that 
while  in  cyclopic  eyes  all  the  parts  may  be  doubled 
or  unite  in  every  degree,  there  is  never  a  single  lens 
or  double  vitreous. 

Q.  Is  this  borne  out  by  other  cases? 

A.  Bock  describes  cases  in  which  the  eye  had  not 
been  formed  by  the  conglomeration  of  two  separately 
developed  eyes,  but  is  a  single  developed  eye;  the 
other  being  wanting  entirely.  A  cyclops,  in  which 
there  was  a  single  socket  for  the  eye,  of  a  lozenge- 
shape,  situated  in  the  lower  middle  of  the  forehead. 
The  socket  was  furnished  with  two  pairs  of  eyelids, 
upper  and  lower.  The  eye  was  found  to  consist  of 
two  rudimentary  retinae,  apparently  springing  from  a 
single  optic  vesicle.  The  nose  was  represented  by  a 
short  process,  attached  to  the  forehead,  above  the 
median  eye. 

Q.  What  dental  deformities  may  a  cyclops  present? 

A.  In  a  cyclops,  born  living,  but  killed  by  pressure 


ON  IRREGULARITIES  OF  THE  TEETH. 


181 


on  the  funis,  the  mouth  contained  an  ivory  tusk-like 
tooth  at  each  corner.  There  was  mane-like  hair  around 
the  neck. 

Q.  What  accompanies  cyclopia? 

A.  Absence  of  both  the  internal  and  external  ear, 
and  synotia  (joined  ears).  In  the  triophthalmic  cases 
the  three  eyes  are  usually  separate ;  two  occupying  the 
usual  position,  while  the  third  is  situated  in  the  center 
of  the  forehead. 

Q.  How  many  cyclops  did  ninety  families  of  degen¬ 
erates  average? 

A.  In  an  average  of  eleven  children  each,  there 
were  five  cyclops. 

Q.  How  does  degeneracy  affect  the  eye? 

A.  Degeneracy,  which  affects  so  deeply  the  devel¬ 
opment  of  the  eye,  naturally  tends  to  evince  itself  in 
other  anomalous  states  in  the  organ.  As  excessive 
asymmetry  of  the  body  is  one  of  the  most  noticeable 
of  the  stigmata  of  degeneracy,  it  is  not  astonishing  to 
find  that  this  asymmetry  expresses  itself  both  in  the 
position  as  well  as  in  the  size  and  structure  of  the  eye. 
Asymmetrical  irides  are  exceedingly  frequent  in  the 
types  of  insanity  due  to  hereditary  defect. 

Q.  What  other  anomalies  are  found  in  the  eyes  of 
degenerates? 

A.  The  conditions  of  the  eye,  known  as  microph¬ 
thalmia  (small  eyes),  macrophthalmia  (big  eyes),  and 
anophthalmia  (absence  of  eyes),  are  found  quite  fre¬ 
quently  in  degenerate  families.  Corectopia  (displace¬ 
ment  of  the  pupil  so  that  it  is  not  in  the  center  of  the 
iris)  often  exists.  Coloboma  (eye  fissure)  is  also  not 
infrequent  among  degenerates. 

Q.  How  do  these  vary? 


182 


QUIZ  COMPEND 


A.  These  vary  greatly  in  situation  and  general 
results.  The  iris  is  sometimes  completely  absent  on 
one  or  both  sides  (aniridia).  Beside  these  anomalies, 
morbid  conditions,  like  retinis  pigmentosa,  congenital 
cataract,  and  macular  degeneracy  are  far  from  infre¬ 
quent  expressions  of  degenerate  taint  of  th©  eye.  The 
organ  in  this  particular  obeys,, the  general  law  that 
degeneracy  may  show  itself  in  the  minute  change, 
resulting  in  disturbances  of  functions  or  that  produc¬ 
ing  disease  or  finally  atavism.  The  defects  of  the  eye 
requiring  glasses  are  exceedingly  frequent  in  degen¬ 
erates  and  aggravate  their  morbidity. 

Q.  Cite  instances  of  eye  degeneracy. 

A.  Female,  age  fourteen.  Patient’s  people  are 
exceedingly  poor  and  so  ignorant  as  to  make  it  impos¬ 
sible  to  get  any  reliable  family  history.  There  are 
four  sisters  and  three  brothers,  all  poor  and  ignorant. 
The  patient  is  idiotic.  She  has  a  retreating  forehead 
and  exceedingly  crooked  nose,  a  very  long,  thin 
neck,  and  an  exceedingly  small,  retrusive  jaw,  the 
lower  incisors  striking  at  least  one-half  inch  behind 
the  upper.  The  teeth  are  exceedingly  irregular.  The 
two  left  upper  incisors  are  large,  the  two  others  very 
small.  Of  the  lower  incisors,  the  two  central  ones 
are  like  mice  teeth,  pointed  and  sharp.  They  are 
separated  at  their  bases,  but  come  together  at  their 
tops,  at  an  acute  angle.  The  other  two  are  conical  and 
lie  each  parallel  to  its  neighbor.  Examination  of 
eyes  reveals  V — fingers  in  one-half  M.  Eyes  small. 
Nystagmus.  Fundi  apparently  normal.  Diagnosis, 
microphthalmus. 

Female,  age  seventeen.  Father  is  deaf.  Could 
obtain  no  history  of  degenerate  stigmata  in  mother. 


ON  IRREGULARITIES  OF  THE  TEETH 


183 


Has  four  sisters  living,  nine  dead.  Has  four  brothers 
living  and  one  dead.  Had  to  depend  on  patient  for 
family  history.  The  patient  is  exceedingly  dull.  It 
is  impossible  for  her  to  learn.  She  has  jaws  that,  at 
the  junction  of  the  premaxillary  and  maxillary  bones, 
present  a  well  marked  angle.  Her  teeth  are  conical. 
The  incisors  are  sharp  and  pointed;  are  like  mice  teeth. 
The  ears  are  small,  and  placed  high  upon  the  head; 
she  is  an  almost  typical  degenerate,  both  physically  and 
mentally.  Examination  of  the  eyes  reveals  V- — can¬ 
not  count  fingers,  but  sees  large  objects. 


CHAPTER  XX. 


DEVELOPMENTAL  NEUROSES  OF  THE  BONES  OF 

THE  EAR. 

Q.  Are  ear  deformities  frequently  found?  ■ 

A.  They  are  very  common.  Total  absence  of  the 
external  as  well  as  embryonic  internal  ear  occurs. 

Q.  Does  it  affect  the  hearing? 

A.  The  exceedingly  primitive  structure  of  the 
internal  auditory  mechanism  necessitates  abnormal 
or  defective  hearing  power. 

Q.  Can  congenital  deaf-mutism  be  thus  accounted 
for? 

A.  There  is  no  question  but  that  arrest  of  develop¬ 
ment  of  the  auditory  mechanism  places  if  in  a  condi¬ 
tion  not  to  appreciate  sound. 

Q.  Does  this  affect  the  child,  though  he  may  not 
have  been  born  deaf? 

A.  Deaf-mutism  from  inability  to  appreciate  sound 
occurs,  and  the  whole  auditory  apparatus  subsequently 
furthers  degeneration. 

Q.  Does  mental  weakness  aggravate  the  conch 
tions? 

A.  It  has  much  to  do  with  such  cases. 

Q.  Are  closure  of  the  Eustachian  tube  and  absence 
of  external  ear  infallible  signs  of  deafness? 

A.  No. 

Q.  Must  the  complicated  mechanism  of  the  ear 
bones  necessarily  be  a  rich  field  for  degeneracy? 

185 


186 


QUIZ  COMPEND 


A.  Yes.  Many  ear  lesions  are  no  doubt  due  to 
such  deformities. 

Q.  Are  deformities  of  the  jaws  and  teeth  common 
among  deaf-mutes? 

A.  Of  143  congenital  deaf-mutes,  ninety-three  per 
cent,  had  deformities  of  the  head,  face,  jaws,  and 
teeth. 


CHAPTER  XXL 


DEVELOPMENTAL  NEUROSES  OF  JAWS  OF  THE 

SEEMINGLY  NORMAL. 

Q.  What  did  the  examination  of  1,000  seemingly 
normal  school  children  show? 

A.  They  showed  normal 76  per  cent.,  large  jaw  1.9 
per  cent.,  protrusion  lower  jaw  .7  per  cent.,  protrusion 
upper  jaw  .7  per  cent.,  high  vault  5.6  per  cent., 
V-shaped  arch  1. 1  per  cent.,  partial  V-shaped  arch 

6.1  per  cent.,  saddle-shaoed  arch  3.3  per  cent,  small 
teeth  3.0  per  cent. 

Q.  What  did  1,000  seemingly  normal  adults  show? 

A.  They  showed  normal  61  per  cent.,  large  jaw 

3.2  per  cent^  height  of  vault  11.0  per  cent.,  V-shaped 
arch  3.5  per  cent.,  partial  V-shaped  7  2  per  cent., 
semi  V-shaped  arch  1.8  per  cent.,  saddle  arch  4  3  per 
cent.,  partial  saddle  5.1  per  cent,,  semi-saddle  3.4  per 
cent. 

Q.  What  variation  is  noticed  in  different  ages? 

A  About  fifteen  per  cent,  more  deformities  in  the 
adult. 

Q  How  may  this  be  explained? 

A  In  two  ways-  (A  That  as  people  grow  older 
slight  irregularities  of  the  teeth  may  become  some¬ 
times  more  prominent,  owing  to  movement  and  per¬ 
manent  arrangement  of  the  teeth  later  in  life.  (2) 
Some  of  those  examined  are  patients  who  presented 
deformities  that  alarmed  them.  The  percentage  of 
deformities  compares  favorably  with  the  percentage 

187 


188 


QUIZ  COMPEND 


of  deformities  of  the  face.  Taken  as  a  whole,  they 
give  an  approximate  idea  of  the  pereent-nge  of  deform¬ 
ities,  in  this  community  at  least. 

Q.  How  do  defectives  compare  with  normal  as 
regards  deformifies?  .  • 

A.  The  percentage  is  from  twenty-five  to  thirty- 
three  per  cent,  less  than  found  in  institutions  for 
defectives. 


CHAPTER  XXII. 


DEVELOPMENTAL  NEUROSES  OF  THE  MAXILLARY 

BONES. 

Q.  Are  excessively  developed  jaws  often  seen? 

A.  Yes.  Either  from  natural  growth  or  disease. 

Q.  At  what  time  does  the  jaw  attain  its  growth? 

A.  It  has  attained  its  full  size  at  from  twenty-five 
to  thirty-five  years  of  age. 

Q.  Why  so  late? 

A.  Because  in  neurotics  and  degenerates  partial 
arrest  takes  place  at  different  periods,  after  which  the 
jaw  will  start  up  again  and  continue  to  growu  Assim¬ 
ilation  is  often  slow,  and  the  building  up  of  structure 
is  not  complete  until  thirty  to  thirty-five. 

Q.  Does  the  jaw  usually  correspond  with  the  shape 
and  size  of  the  head? 

A.  Other  things  being  equal,  a  large  head  will 
contain  a  large  jaw,  a  small  head  a  small  jaw,  a  broad 
head  a  broad  jaw,  a  long  head  a  long  jaw. 

Q.  Does  the  opposite  sometimes  occur? 

A.  Yes.  Occasionally  a  very  small  jaw  is  observed 
in  a  very  large  head,  and  vice  versa. 

Q.  Are  both  jaws  uniformly  affected? 

A.  They  are  not.  The  upper  jaw  is  more  subject 
to  morbid  influences  than  the  lower. 

Q.  Why? 

A.  Because  it  is  connected  with  the  bones  of  the 
head,  of  which  it  is  a  part.  As  a  fixed  bone  the  blood 
supply  is  reduced. 


189 


190 


QUIZ  COMPEND 


Q.  How  about  the  lower? 

A.  While  the  lower  rarely  exceeds  the  average,  a 
constant  use  and  mobility  has  a  tendency  to  keep  it 
normal  The  influence  which  tends  to  check  the 
upper  is  in  the  lower,  thus  overbalanced  by  its 
mobility 

Q.  Does  use  increase  the  size  o-f  the  jaw? 

A.  Constant  use  increases  the  size,  as  in  acrobats, 
tobacco  chewers,  singers,  public  speakers,  and  in  the 
early  races,  which  lived  upon  shells,  roots,  etc. 

Q.  Does  enlargement  of  the  maxillaries  occasion 
dental  irregularities? 

A.  Yes.  The  teeth  of  one  jaw  may  extend  inside 
or  outside  of  those  on  the  opposite  jaw. 

Q.  What  diseases  may  cause  this  enlargement? 

A.  Hypertrophy  on  the  one  hand,  hyperplasia  on 
the  other,  as  well  as  osteitis  and  periostitis. 

Q.  Will  diseases  of  the  antrum  cause  enlargement 
of  the  upper  jaw? 

A.  Yes.  Diseases  of  the  antrum  and  nasal  fossae 
will  produce  the  same  result. 

Q.  Does  syphilis  affect  the  jaws? 

A.  Yes.  Hereditary  syphilis  has  a  special  predi¬ 
lection  for  the  bones  of  the  face  and  jaws.  This  is  no 
doubt  due  to  their  transitory  nature.  Especially  is 
this  true  of  the  alveolar  processes. 

Q.  Is  the  same  form  of  irregularities  of  the  teeth 
found  in  large  jaws  as  small? 

A.  V  and  saddle-shaped  arches,  with  their  modifi¬ 
cations,  are  never  found  in  large  arches. 

Q.  In  what  disease  of  children  are  jaw  abnormali¬ 
ties  liable  to  occur? 

A.  In  rachitis,  whether  due  to  syphilis  or  not, 


ON  IRREGULARITIES  OF  THE  TEETH. 


191 


hypertrophy  and  hyperplasia  may  be  localized  in 
some  portion  of  the  jaw,  causing-  it  to  be  unevenly 
developed. 

Q.  Is  there  jaw  as  well  as  face  asymmetry? 

A.  Yes.  It  is  very  common  among  neurotics  and 
degenerates,  and  among  the  offspring  of  mixed  races. 

Q.  Why? 

A.  Each  lateral  half  of  the  body  develops  inde¬ 
pendently  of  the  other.  The  same  is  also  true  of  the 
jaws.  Each  has  its  own  peculiarities.  Asymmetry, 
therefore,  is  caused  from  the  inharmonious  lateral 
development  of  the  parts. 

Q.  Is  it  common? 

A.  Extreme  asymmetry  of  the  lateral  halves  is 
often  seen.  Although  it  may  not  affect  the  contour 
of  the  face,  it  causes  faulty  articulation  of  the  teeth 
upon  that  side  of  the  face. 

Q.  What  is  a  local  cause  of  asymmetry  of  the  face? 

A.  A  full  set  of  teeth  upon  one  side  with  mastica¬ 
tion  upon  that  side  alone;  on  the  other  side  one  or 
more  teeth  may  have  been  extracted,  or  they  may  not 
erupt,  or  they  may  have  moved  forward  upon  one  side. 
In  any  of  these  conditions  the  alveolar  process  and 
jaws  would  become  shorter  on  one  side  than  on  the 
other. 

Q.  What  is  this  deformity  called? 

A.  Haskell’s  deformity. 

Q.  Why? 

A.  Because  Dr.  L.  P.  Haskell  first  called  the 
attention  to  it. 

Q.  In  this  deformity  what  produces  marked  depres¬ 
sion  on  the  side  of  the  face? 

A.  It  is  properly  due  to  asymmetry  in  the  develop- 


192 


QUIZ  COMPEND 


ment  of  the  two  halves  of  the  face.  In  mastication 
and  in  the  eruption  of  the  teeth  they  are  forced  into  a 
larger  circle;  in  this  manner  the  circle  of  the  alveolar 
process  becomes  larger  than  the  circle  of  the  jaw 
proper. 

Q.  Is  it  customary  to  masticate  upon  both  sides  of 
the  mouth? 

A.  Yes.  Although  just  as  a  person  is  right  and 
left  handed,  so  may  he  masticate  either  upon  the  right 
or  left  side. 

Q.  Are  these  deformities  apparent  to  the  casual 
observer? 

A.  They  are  not.  Only  when  artificial  teeth  are 
inserted,  or  an  irregularity  corrected,  can  these 
deformities  be  detected. 

Q.  Are  not  the  rami  frequently  abnormally  devel¬ 
oped? 

A.  They  are.  It  is  not  uncommon  to  find  one 
ramus  from  one-fourth  to  one-half,  and  sometimes 
three-fourths  of  an  inch  shorter  than  that  on  the  other 
side. 

Q.  What  effect  does  it  have  upon  the  body  of  the 
iaw  and  the  teeth? 

A.  It  throws  the  jaw  and  teeth  to  one  side,  making 
a  marked  deformity.  • 

Q.  May  not  the  body  of  the  jaw  be  longer  and 
larger  upon  one  side  than  upon  the  other? 

A.  It  is  not  uncommon  to  find  one  side  longer  than 
the  other. 

Q.  How  can  this  be  detected? 

A.  By  the  position  of  the  median  line,  and  also  by 
the  occlusion  of  the  teeth. 

Q.  Where  the  inferior  maxilla  is  normal  or  exces- 


193 


ON  IRREGULARITIES  OF  THE  TEETH. 

sively  developed,  the  superior  maxilla  quite  small, 
and  the  alveolar  process  thin,  what  may  occur? 

A.  This  condition  will  force  the  lower  jaw  and 
teeth  against  the  upper,  carrying  the  teeth  and 
alveolar  process  forward,  producing  a  marked  protru¬ 
sion  of  the  process  and  teeth. 

Q.  What  effect  has  this  condition  in  negroes? 

A.  It  has  a  tendency  to  perpetuate  the  prognath¬ 
ism  of  the  jaws. 

Q.  What  other  cause  may  produce  this  deformity? 

0 

A.  A  short  rami. 

Q.  What  effect  does  such,  a  deformity  have  upon 
the  face? 

A.  It  usually  produces  marked  depression  of  the 
face  at  the  alae  of  the  nose. 

Q.  When  the  superior  maxilla  is  fully  developed, 
and  the  lower  jaw  cannot  force  the  teeth  and  alveolar 
process  forward,  what  results? 

A.  The  first  molars  erupt  normally  and  occlusion 
is  perfect  until  the  second  teeth  come  into  place. 
Owing  to  the  short  rami  the  harmony  is  lost,  and  the 
second  molars  only  articulate.  The  anterior  part  of 
the  mouth  remains  open. 

Q.  When  excessive  development  of  the  rami  takes 
place,  what  occurs? 

A.  The  body  of  the  lower  jaw  may  be  brought 
forward,  so  that  it  protrudes  quite  a  distance  beyond 
the  upper. 

Q.  Can  the  rami  be  normal  while  the  body  is  exces¬ 
sively  developed? 

A.  Yes.  Such  a  case  was  observed  in  a  School  of 
Idiocy  in  Hamburg.  The  inferior  incisors  extended 
one  inch  beyond  those  of  the  upper. 


194 


QUIZ  COMPEND 


Q.  When  the  mobility  of  the  lower  jaw  is  favora¬ 
ble  to  a  healthy,  normal  development,  does  the  jaw 
ever  become  arrested? 

A.  It  is  not  uncommon  to  find  the  jaw  arrested; 
when  this  is  the  case  the  person  has  the  appearance  of 
having  lost  the  chin. 

Q.  What  peculiar  feature  has  the  Yankee  or  Amer¬ 
ican  type  of  jaw? 

A.  It  has  a  short  rami,  long  slim,  body  and  pro¬ 
truding  chin.  The  face  is  thin.  The  alveolar  process 
and  teeth  are  normal.  Delicate  muscles  and  tendons 
are  associated  with  such  bones, 

Q.  Will  not  such  a  jaw  become  easily  dislocated? 

A.  Dislocation  is  liable  to  occur  while  yawning  or 
during  dental  operations.  Great  care  should  be  used 
to  avoid  too  much  leverage. 

Q.  Does  not  the  superior  maxilla  sometimes  shut 
inside  of  the  lower? 

A.  Occasionally  the  upper  jaw  will  become  arrested 
to  the  extent  that  it  will  entirely  close  inside  the 
lower,  as  in  the  case  of  Charles  V.  of  Germany. 

Q.  Do  extreme  cases  of  abnormal  jaw  development 
occur? 

A.  Complete  absence  of  the  inferior  maxilla  occurs, 
but  is  rarer  in  man  than  in  animals.  It  has  been 
most  noted  in  sheep.  On  the  other  hand,  excessive 
development  of  the  lower  jaw  in  the  bull-dog  is  quite 
common. 


/ 


CHAPTER  XXIII. 


DEVELOPMENTAL  NEUROSES  OF  THE  VAULT. 

Q.  Who  first  called  attention  to  the  relation  of  the 
palate  or  vaults  in  idiots? 

A.  Dr.  Langdon  Down.  After  careful  measure¬ 
ment  of  the  mouths  of  the  congenitally  feeble-minded 
and  of  intelligent  people  he  found  that  there  was 
a  markedly  diminished  width  between  the  posterior 
bicuspids  of  the  two  sides.  One  result,  or  rather  accom¬ 
paniment  of  the  narrowing  is  the  inordinate  vault¬ 
ing  of  the  palate.  It  assumed  a  roof-like  form.  The 
vaulting  is  not  simply  apparent  from  the  approximate; 
it  is  absolute.  The  line  of  juncture  between  the 
palatal  bone  occupying  a  higher  plane. 

Q.  What  did  he  conclude? 

A.  That  the  condition  of  the  mouth  is  important  in 
determining  whether  the  lesion  on  which  the  mental 
weakness  depends  is  of  intra-uterine  or  post-uterine 
origin.  In  the  event  of  the  mouth  being  abnormal, 
it  indicates  a  congenital  origin,  while  if  the  mouth  is 
well  formed,  and  the  teeth  are  in  a  healthy  condition, 
it  would  lead  to  the  opinion  that  the  condition  had 
occurred  subsequently  to  embryonic  life. 

.  Q.  What  do  these,  when  found  in  children,  indi¬ 
cate,  according  to  Dr.  Down? 

A.  Idiocy.  But  while  many  idiots  and  imbeciles 
have  low,  narrow  vaults,  many  sane  people  have  high 
vaults,  and  V-shaped  and  saddle  arches. 

195 


16 


196 


QUIZ  COMPEND 


O.  What  did  Clay  Shaw  decide? 

A.  His  researches  showed  that  while  there  is  no 
necessary  connection  between  a  high  palate  and  a 
degree  of  mental  capacity  of  the  individual,  a  high 
palate  is  invariably  associated  with  narrow  pterygoid 
width  and  a  narrow  skull. 

Q.  On  examination  of  Clay  Shaw’s  results,  what 
conclusion  was  arrived  at? 

A.  That  the  intellectual  standard  adopted  was  too 
limited  to  admit  of  his  sweeping  assertion  as  regards 
mental  capacity. 

O.  What  was  further  shown? 

A.  The  claim  anent  narrow  skull  and  high  palate 
is  a  sweeping  assertion,  based  on  a  few  selected  cases. 
Examination  of  the  skulls  in  any  moderately-sized 
anthropologic  collection  will  disprove  this  assertion. 

Q.  What  is  Cuyfitz’s  theory? 

A.  The  claim  of  the  connection  of  high  vaulted 
palate  with  mental  deficiency,  asserted  in  explanation 
that  the  brain  tends  to  develop  transversely,  but 
meets  in  some  cases  a  resistance  in  the  parietal  region, 
which  crowds  it  back.  This  pressure  is  transmitted  by 
the  zygomatic,  temporal,  and  malar  processes  pushing 
together;  the  alveolar  borders  of  the  superior  maxil¬ 
lary,  like  a  workman’s  tongs,  bring  the  ends  together. 

Q.  Does  this  theory  seem  plausible? 

A.  While  this  explanation  is  exceedingly  ingenious, 
it  is  as  yet  in  the  earliest  stages  of  a  working  hypoth¬ 
esis. 


Q.  What  is  idiocy? 

A.  It  is  but  a  bud  on  the  tree  of  degeneracy,  and 
many  conditions  of  checked  development  found  in 
idiocy  are  found  in  other  forms  of  degeneracy  as  well. 


ON  IRREGULARITIES  OF  THE  TEETH. 


197 


Q.  What  has  been  the  theory  since  Imrie’s  time? 

A.  The  theory  that  rabbit-mouth  is  due  to  keeping 
the  thumb  in  the  mouth  for  hours  after  going  to  sleep, 
has,  with  various  modifications,  but  without  careful 
analysis,  been  repeatedly  reiterated  in  parrot-like 
fashion. 

Q.  Who  was  the  first  to  corroborate  Imrie? 

A.  Thomas  Ballard  claimed  that  “as  in  idiots  are 
seen  the  worst  forms  of  deformed  growth,  so  also  do 
they  exhibit  the  most  aggravated  forms  of  deformed 
,  jaws  and  teeth,  the  habit  of  sucking  being  retained 
by  them  to  advanced  age.” 

Q.  Why  is  thumb-sucking  an  illogic  theory? 

A.  When  the  size  of  the  vault,  especially  its 
anterior-posterior  diameter,  is  compared  with  the 
thumb,  lip,  tongue,  sugar  teat,  etc.,  it  is  evident  that 
depression  made  by  them  could  not  produce  uniform 
width  and  height  throughout  the  entire  length  of  the 
vault. 

Q.  How  early  do  children  commence  to  suck  their 
fingers? 

A.  Soon  after  birth.  As  absorption  and  deposi¬ 
tion  of  bone  cells  take  place  faster  at  that  time  than 
at  any  other  in  life,  high,  narrow,  deformed  vaults 
would  be  expected  in  connection  with  the  first  set  of 
teeth  or  before  the  sixth  year,  but  such  is  not  the  case. 
Children  wfith  the  habit  of  finger^sucking  often  have 
very  low  vaults. 

Q.  What  were  Clouston’s  conclusions? 

A.  He  divides  vaults  into  three  groups,  typical  (or 
normal),  neurotic,  and  deformed.  The  first  has  a  low, 
but  regular  wide  dome.  The  second  type  is  designated 
as  neurotic,  because,  according  to  Clouston,  the  “de- 


198 


QUIZ  COMPEND 


formity  of  the  palate  occurs  during  the  brain  growth 
early  in  life,  probably  in  utero,  ”  and  the  third  is 
designated  as  deformed. 

Q.  Are  these  conclusions  of  value? 

A.  They  are  not,  since  they  are  largely  based  on 
preconceived  notions,  which  ignore  the  researches  of 
comparative  anatomists,  of.  alienists  of  world-wide 
fame,  of  embryologists,  of  ethnologists  and  of  crimi¬ 
nal  anthropologists. 

Q.  In  a  general  way,  what  are  the  theories  of 
Clouston,  Langdon  Down,  and  Cole? 

A.  That  excessive  vaulting  of  the  palate  is  due  to 
arrest  of  development  of  the  sphenoid  bone  and  pre¬ 
mature  ossification  of  the  sutures  at  the  base  of  the 
skull. 

Q.  What  precludes  these  theories? 

A.  If  the  intervening  space  between  the  base  of 
the  brain  and  the  vault  were  solid,  a  change  in  shape 
of  one  might  exert  an  influence  upon  the  other.  The 
space  occupied  by  the  nares  being  located  between  the 
two,  with  two  strong  pillars  of  the  superior  maxil¬ 
lary  bones  upon  either  side  as  a  resistance,  precludes 
such  a  theory.  That  any  force  produced  by  the  devel¬ 
opment  of  the  bone  at  the  base  of  the  skull,  or  early  or 
retarded  ossification  of  suture  in  that  locality,  could 
exert  an  influence  through  the  vomer  is  not  well 
taken. 

Q.  What  are  other  evidences  that  influences  in  this 
direction  cannot  change  the  shape  of  the  vault? 

A.  The  fact  that  the  vomer  does  not  ossify  until 
puberty,  the  thinness  of  the  bone  after  ossification,  and 
that  it  is  always  crimped  or  deflected  in  one  direction 
or  another,  is  evidence  that  no  effect  could  be  pro- 


ON  IRREGULARITIES  OF  THE  TEETH. 


199 


duced  upon  a  vault  of  bone,  supported  by  the  anterior 
alveolar  process,  and  with  a  rib  or  suture  extending  its 
entire  length,  which  ossified  years  before  any  change 
in  the  vault  was  noticed. 

Q.  Does  the  theory  of  Clouston  that  “the  deform¬ 
ity  of  the  palate  occurs  during  brain  growth  early  in 
life,  probably  in  utero, ’’  seem  plausible? 

A.  It  does  not.  The  brain  continues  to  grow  until 
the  sixth  or  seventh  year.  The  vault  does  not  change 
very  much  until  after  the  second  teeth  erupt,  after  the 
sixth  year,  lienee  a  high  vault  cannot  be  said  to 
develop  early  in  life,  much  less  in  , utero. 

O.  What  is  Ivy’s  theory? 

A.  That  dental  and  facial  types  are  a  part  of  the 
morphology  of  the  temperaments.  That  the  vault  is 
indicative  of  the  several  temperaments.  That  the 
vault  of  the  bilious  temperament  is  about  flat,  the 
dome  of  .  the  mouth  is  high  and  about  square.  The 
sanguine  vault  resembles  a  horse-shoe  in  shape,  the 
dome  of  the  mouth  is  high  and  semi-circular.  The 
nervous-temperament  vault  is  Gothic,  from  its  pointed 
character.  The  lymphatic  vault  is  also  semi-circular, 
and  somewhat  resembles  that  of  the  sanguine  temper- 
ament. 

Q.  Do  these  theories  seem  plausible? 

A.  They  do  not.  The  mouths  of  each  class, 
bilious,  sanguine,  nervous,  or  lymphatic,  may  range 
from  2.50  inches  across  from  one  second  bicuspid  to 
that  of  the  other  side,  down  to  .96  inches  in  width,  and 
the  antero- posterior  diameter  from  2.43  down  to  1.86 
inches.  The  height  of  vault  from  .86  down  to.  25 
inches.  These  figures  in  themselves  preclude  any  such 
classification. 


200 


QUIZ  COMPEND 


Q.  How  would  heredity  affect  the  vaults? 

A.  Two  individuals,  one  a  nervous,  the  other  a 
lymphatic,  bilious,  or  sanguine  temperament,  are 
married,  the  offspring  inherits  the  jaws  of  one,  the 
teeth  of  the  other;  the  temperament- of  the  child  is 
changed.  One  child  may  possess  a  broad  dental 
arch,  but  very  short,  another  a  very  narrow,  long 
dental  arch.  Hence  classification  of  the  dental  arch 
and  vault  by  temperaments  is  out  of  the  question. 

Q.  Is  there  further  evidence  that  such  classifica- 
tion  is  impossible? 

A.  Investigations  were  carried  out  upon  brachy- 
cephalic,  mesocephalic,  and  dolichocephalic  individu¬ 
als,  which  demonstrated  that  classification  of  vaults  by 
the  shape  of  the  head  could  not  be  accomplished. 

O.  What  other  theories  have  received  much  en- 
couragement? 

A.  Mouth-breathing  has  been  advanced  as  a  cause 
of  high  vaults,  and  is  still  held  by  medical  men  and 
dentists. 

Q.  How  is  mouth-breathing  produced? 

A.  That  mouth-breathing  is  caused  by  sleeping 
with  the  mouth  open,  by  enlargement  of  the  tonsils, 
by  adenoid  growth,  by  hypertrophy/  of  the  mucous 
membrane  of  the  nose  and  turbinated  bones,  and  by 
arrest  of  development  of  the  nose  and  upper  jaw. 

Q.  What  theory  has  been  advanced  as  to  the  effect 
upon  the  jaws  and  teeth? 

A.  The  mouth  being  open,  pressure  is  brought 
upon  the  jaws  and  teeth  by  the  buccinator  muscles, 
causing  contraction  of  the  dental  arches. 

O.  Is  such  a  theory  in  harmony  with  the  facts? 

A.  It  is  not.  The  buccinator  muscle  is  a  voluntary 


*  l 

ON  IRREGULARITIES  OF  THE  TEETH.  201 

muscle,  penniform  in  shape.  It  has  its  origin  and 
insertion  along  the  body  of  the  jaws,  above  and  below 
the  alveolar  process.  It  extends  from  the  first 
bicuspid  anteriorly  to  the  third  molar  posteriorly.  Its 
chief  function  is  to  convey  and  hold  food  under  the 
teeth  in  mastication.  Being  a  voluntary  muscle  it 
could  not  contract  during  sleep. 

Q.  Does  mouth-breathing  commence  very  early  in 
life? 

A.  Yes.  Contracted  jaws  and  vaults  are  never 
seen  until  after  the  sixth  year.  If  they  exist  they  are 
premature  senilities  or  due  to  traumatic  causes. 

Q.  Are  high  vaults  and  contracted  arches  always 
present  in  mouth-breathing? 

A.  Only  in  a  very  small  percentage. 

Q.  How  the  mouth  opened  in  mouth¬ 

breathing? 

A.  The  lower  jaw  drops  just  enough  to  allow  the 
same  volume  of  air  to  enter  that  would  pass  through 
the  nose,  about  one-half  inch. 

Q.  Do  old  people  sleep  with  the  mouth  open? 

A.  They  do.  Not  from  closure  of  .  the  nostrils, 
however,  but  on  account  of  relaxation. 

Q.  If  mouth-breathing  were  the  cause  of  contracted 
dental  arches,  would  it  have  any  effect  upon  the  jaws 
and  teeth  in  old  age? 

A.  It  would  not,  because  the  deformity  is  always 
complete  by  the  twelfth  year. 

Q.  Is  there  tension  upon  the  dental  arches  when 
the  mouth  is  opened? 

A.  There  is  not.  When  the  mouth  is  open  there 
is  a  slight  sense  of  tension  of  the  orbicularis  oris,  but 


202 


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not  of  the  buccinator,  no  matter  how  wide  the  mouth 
is  opened. 

Q.  If  it  were  possible  for  the  buccinator  to  exert 
pressure,  would  it  produce  the  V-shaped  arch? 

A.  It  is  an  impossibility,  because  it  does  not 
extend  forward  far  enough. 

Q.  Having  disposed  of  the  V-shaped  vault,  what 
effect  would  the  buccinator  muscle  have  upon  the 
saddle-shaped  dental  arch? 

A.  As  has  already  been  said,  this  muscle  is  a  pen- 
niform  structure.  The  center  of  contraction  is  at,  or 
about,  the  first  molar  tooth.  The  first  permanent 
molar  and  the  teeth  posterior  to  it  are  never  involved 
in  either  deformity,  only  the  teeth  anterior  to  the  first 
permanent  molar. 

Q.  That  being  the  case,  could  not  one-half  of  the 
muscles  act  upon  the  bicuspids  and  cuspids? 

A.  Suppose  one-half  of  the  muscles  could  contract 
upon  these  teeth,  the  result  would  be  that  the  deform¬ 
ity  would  be  uniform  upon  both  sides,  and  always 
alike  on  each  side. 

Q.  Is  not  that  the  case? 

A.  It  never  is  the  case.  Frequently  only  one  tooth 
is  inside  of  the  arch;  again  one  is  on  the  outside. 

Q.  Does  the  theory  seem  tenable? 

A.  It  is  perfectly  absurd;  since  the  dental  arch  is 
not  unlike  the  arch  of  a  bridge,  or  the  arch  in  a  build¬ 
ing,  pressure  exerted  upon  the  outside  would  have  no 
effect  upon  it.  If  such  a  theory  were  correct,  what 
would  be  the  cause  of  the  partial  V  and  saddle,  and 
the  semi-V  and  saddle  arches? 

Q.  Is  there  further  evidence  that  mouth-breathing 
is  not  the  cause  of  these  deformities? 


ON  IRREGULARITIES  OF  THE  TEETH 


203 


A.  In  the  mouths  of  twenty-four  mouth-breathers 
not  a  single  complete  V  or  saddle  arch  was  observed 
Partial  V  and  saddle  and  semi-V  and  saddle  arches 
were  common,  but  in  no  case  were  there  any  two  alike. 

Q.  How  are  deformed  vaults  accounted  for? 

A.  By  studying  their  development,  the  production 
of  normal  and  deformed  vaults  can  be  understood. 

Q.  How  was  this  accomplished? 

A.  First,  by  settling  the  question  that  deformed 
vaults  are  not  observed  among  children  with  tempo¬ 
rary  teeth.  The  jaw  grows  from  birth  until  the  second 
period  of  stress,  about  the  sixth.  It  is  at  this  period 
that  the  second  set  erupt.  vSecond,  thirty-six  impres¬ 
sions  of  the  mouths  of  children,  ranging  from  six  to 
twelve  years,  were  taken  and  casts  obtained. 

Q.  Were  the  children  picked  cases? 

A.  They  were  not,  only  so  far  as  age  was  con¬ 
cerned.  The  impressions  were  taken  in  modelling 
compound  to  get  an  accurate  impression  of  the  soft 
palate.  Measurements  were  first  taken,  and  then  the 
models  were  sawed  at  the  median  line. 

Q.  How  were  the  lines  traced? 

A.  They  were  placed  upon  paper  and  traced.  They 
were  then  glued  together  and  sawed  transversely 
anterior  to  the  first  permanent  molar.  They  were 
again  placed  on  paper,  and  traced  transversely.  In 
this  way  the  illustrations  were  accurately  outlined. 

Q.  Were  the  plates  made  of  the  models  before  they 
were  cut  into  sections? 

A.  They  were,  and  may  be  found  in  the  third 
edition  of  Talbot’s  work.  These,  together  with 
plates  one  to  twelve  in  the  appendix,  give  a  very  good 


204 


QUIZ  COMPEND 


idea  of  the  progress  of  development  of  the  permanent 
teeth  and  alveolar  process. 

Q.  Were  the  changes  very  great  at  first? 

A.  There  were  three  models  at  six  years,  and  three 
at  seven.  The  changes  in  the  vault  are  so  slight  that 
more  would  be  useless. 

Q.  What  does  this  signify? 

A.  That  only  the  first  permanent  molars  were  in 
place,  and  that  the  change  in  the  alveolar  process  only 
takes  place  when  the  second  teeth  come  into  place. 

Q.  What  is  the  condition  of  the  vault  at  this  time? 

A.  In  a  general  way  the  vaults  are  quite  low  and 
without  character. 

Q.  What  does  a  cross  section  show? 

A.  It  shows  that  the  vault  is  quite  narrow  at  the 
upper  portion,  and  the  lines  in  either  direction 
diverge  until  the  teeth  are  reached.  The  teeth  also 
diverge  outward. 

O.  What  is  the  condition  of  the  alveolar  process? 

A.  The  alveolar  process  is  quite  thick  at  six  and 
seven  years,  but  lengthens  and  becomes  thinner  as 
age  advances. 

Q.  What  causes  the  thickness? 

A.  The  antrum  is  situated  between  the  inner  and 
outer  plate  of  bone,  and  the  scanty  alveolar  process 
contains  not  only  the  roots  of  the  temporary  teeth  but 
also  the  crowns  of  the  permanent  teeth. 

Q.  Is  advance  in  height  of  vault  very  rapid? 

A.  It  is  not.  The  advance  is  very  gradual  from 
year  to  year,  yet  taken  as  a  whole,  from  the  sixth  to 
the  twelfth  year  there  is  quite  an  advance  in  height. 

Q.  When  is  the  normal  height  attained? 

A.  When  all  of  the  permanent  teeth  are  in  posi- 


ON  IRREGULARITIES  OF  THE  TEETH.  . 


205 


tion  and  the  alveolar  process  has  developed  about 
them. 

O.  Do  the  two  sides  develop  the  same  length? 

A.  With  but  fewexceptions  they  will  be  nearly  alike. 

O.  Does  the  vault  along  the  median  line  change  its 
shape  in  any  way  while  this  development  is  going  on? 

A.  It  does  not.  The  change  is  always  at  the 
alveolar  process.' 

O.  When  does  the  greatest  change  take  place  in 
the  alveolar  process  and  vault? 

A.  Between  the  ninth  and  twelfth  year,  when  the 
bicuspids  come  into  place.  It  is  at  this  period  that 
the  vault  takes  on  character  in  outline. 

O.  When  do  the  changes  which  produce  deform¬ 
ities  in  the  vault  begin? 

A.  About  the  tenth  or  eleventh  year,  or  when  the 
bicuspids  erupt,  the  change  takes  place,  and  from  that 
time  on  until  all  are  in  place. 

Q.  Is  the  vault  deformity  due  to  erupting  teeth? 

A.  Yes. 

Q.  Does  the  character  of  the  deformed  vault  depend 
entirely  upon  the  shape  of  the  alveolar  process,  and 
the  shape  of  the  alveolar  process  upon  the  shape  and 
position  of  the  teeth? 

A.  This  is  true. 

Q.  What  determines  the  shape  of  the  dental  arch? 

A.  The  eruption  of  the  teeth  is  purely  mechanical. 
The  size  of  the  jaw  is  the  basal  principle.  The  charac¬ 
ter  and  severity  of  the  deformity  depend  upon  the 
order  of  development. 

Q.  What  is  meant  by  the  size  of  the  jaw  being  the 
basal  principle? 

A.  If  the  jaw  be  smaller  than  the  long  diameter  of 


206 


QUIZ  COMPEND 


the  teeth,  or  in  other  words,  if  arrest  of  development 
has  taken  place,  then  the  teeth  will  come  in  irregularly? 

O.  What  are  the  types  of  the  dental  arches? 

A.  The  two  principal  types  are  V  and  saddle 
arches;  all  other  forms  are  modifications  of  these  two 
forms. 

Q.  What  effect  have  local  irregularities  of  the  teeth? 

A.  The  vaults  often  become  deformed  from  local 
irregularities. 

Q.  Does  the  suture  become  excessively  developed? 

A.  It  does.  It  may  develop  as  early  as.  the  second 
and  as  late  as  the  thirty-sixth  year.  ^ 

Q.  What  is  the  cause  of  excessive  development? 

A.  It  is  due  to  irritation  in  mastication  ;  ossification 
varies  in  different  persons. 

Q.  Does  this  excessive  development  vary  in  differ¬ 
ent  individuals? 

A.  It  does.  It  takes  different  shapes  and  forms. 
This  in  228  Peruvian  skulls,  240  Stone  Grave  skulls, 
and  twenty-one  Mound  Builders’  skulls,  sixteen  Peru¬ 
vians,  thirty-nine  Stone  Grave  and  one  Mound  Builder 
had  rope-like  projections  extending  the  entire  length 
of  the  suture.  This  development  was  unlike  the  ex¬ 
cessive  development  of  modern  skulls.  It  had  the 
appearance  of  having  been  made  and  then  glued  upon 
the  suture. 

Q.  How  do  these  sutures  differ? 

A.  They  vary  in  proportion  to  the  width  of  the 
arch.  In  narrow  arches  the  suture  is  low  or  thick, 
which  in  a  normal  arch  is  flat.  The  grooves  on  either 
side  of  the  suture  are  not  uniform,  one  side  being 
deeper  than  the  other. 

Q.  What  are  some  of  the  theories  as  to  cause? 


ON  IRREGULARITIES  OF  THE  TEETH. 


207 


A.  Clouston  says,  “those  palates  where  the  de¬ 
formity  consists  in  a  ridge  down  the  center  antero- 
posteriorly,  seem  to  show  that  in  them  the  deformity 
took  place  at  a  later  period  than  in  the  other  deformed 
palates.”  When  the  nasal  septum  was  getting  strength 
and  kept  the  center  of  the  palate  down,  while  on  each 
side  of  it  the  palate  was  drawn  up,  making  two 
vaults,  side  by  side,  instead  of  one? 

Q.  Is  hypertrophy  more  common  in  neurotics  and 
degenerates  than  in  normal  people? 

A.  Yes,  since  the  suture  is  slower  in  ossifying. 

Q.  Are  they  visible  as  early  as  two  years  of  age? 

A.  Yes,  they  are  very  distinctly  seen. 

Q.  Does  the  depression  on  the  side  of  the  ridge 
vary  in  shape? 

A.  The  ridge  takes  so  many  different  shapes  that 
when  a  number  of  models  containing  it  are  examined, 
the  theory  that  the  sides  are  drawn  or  pushed  up 
appear  more  and  more  untenable. 

Q.  Where  are  these  grooves  located? 

A.  Sometimes  in  the  posterior  third,  again  in  the 
middle  third,  and  still  again  in  the  anterior  third, 
including  deep  grooves  in  the  alveolar  process.  The 
vomer  certainly  could  not  have  any  effect  upon  the 
ridge  or  depression  in  that  part  of  the  mouth. 

Q.  Will  hypertrophy  account  for  all  the  depres¬ 
sions  in  the  vault? 

A,  No.  Some  result  from  hypertrophy  of  the 
alveolar  process. 

Q.  May  a  deep  groove  occasionally  be  seen  along 
the  line  of  the  suture? 

A.  Yes.  It  seems  due  to  arrest  of  development  of 


208 


QUIZ  COMPEND 


the  suture  with  hypertrophy  of  the  bone  and  mucous 
membrane. 

Q.  Is  it  always  uniform? 

A.  No.  Sometimes  it  is  shallow,  again  deeper, 
sometimes  broad,  and  again  narrow,  dependent  upon 
the  extent  of  the  hypertrophy. 

O.  How  are  these  deformities  produced? 

A.  The  lower  jaw  develops  laterally  faster  than  the 
upper,  thus  crowding  the  superior  maxillary  bone 
apart  in  mastication. 

Q.  Can  this  spreading  be  demonstrated  in  another 
way? 

A.  The  space  between  the  central  incisors  is  a 
marked  illustration.  The  development  of  bone  in  the 
suture  is  so  hard  that  it  is  difficult  to  draw  the  teeth 
together.  It  is  more  difficult  to  keep  them  in  posi¬ 
tion. 

0.  What  conditions  of  the  jaws  are  noticed  when 
grooves  are  present? 

A.  When  grooves  are  found  in  the  vaults,  there 
are  most  always  small  contracted  jaws.  The  alveolar 
process  is  nearer  the  center  of  the  vaults.  This, 
together  with  the  ridge,  produces  the  grooves. 


* 


CHAPTER  XXIV. 


DEVELOPMENTAL  NEUROSES  OF  THE  PALATE. 

Q.  In  embryonic  life  how  are  the  nares  separated 
from  the  mouth? 

A.  By  a  partition  between  the  nasal  pits  and  the 
cavity  of  the  mouth. 

Q.  What  becomes  of  this  partition? 

A.  It  becomes  the  true  hard  palate,  containing  the 
intermaxillary  bones. 

Q.  What  two  cavities  are  then  found? 

A.  Above  this  partition  are  the  two  nasal  cavities; 
below,  the  oral  cavity. 

Q.  What  structure  is  then  added? 

A.  The  soft  palate. 

Q.  What  cavities  does  it  separate? 

A.  The  upper  respiratory  passage  and  a  lower 
lingual  or  digestive  passage. 

Q.  How  are  they  developed? 

A.  By  two  shelf-like  growths  on  the  inner  side  of 
each  maxillary  process. 

Q.  Where  do  they  unite? 

A.  The  union  is  completed  at  the  median  line. 

Q.  What  becomes  of  these  palate  shelves? 

A.  They  descend  a  certain  distance  into  the 
pharynx,  but  in  the  pharynx  their  growth  is 
arrested. 

Q.  What  becomes  of  them? 

A.  At  first  they  project  obliquely  downward  toward 

209 


210 


QUIZ  COMPEND 


the  floor  of  the  mouth.  The  tongue  rises  high  between 
them  and  appears  in  sections,  which  pass  through  the 
internal  nares,  to  be  about  to  join  the  internasal 
septum. 

Q.  What  becomes  of  the  floor  of  the  mouth? 

A.  As  the  lower  jaw  grows  the  floor  of  the  mouth 
is  lowered,  and  the  tongue  is  thereby  brought  farther 
away  from  the  internasal  septum. 

Q.  What  becomes  of  the  palate  shelves? 

A.  They  take  a  more  horizontal  portion,  and  have 
turned  the  median  line  above  the  tongue  and  below 
the  nasal  septum  to  meet  and  unite. 

Q.  Where  do  the  shelves  meet  first? 

A  In  front,  toward  the  lip,  and  then  behind 
toward  the  pharynx  later. 

Q.  At  what  period  of  the  embryo  does  this  union 
begin? 

A.  At  eight  weeks,  and  at  nine  weeks  is  completed 
for  the  hard  palate;  at  eleven  weeks  for  the  soft 
palate. 

Q.  Where  do  the  palate  shelves  extend? 

A.  Back  across  the  second  and  third  brachial 
arches,  by  the  migration  of  the  first  gill  cleft,  or  in 
other  words,  of  the  Eustachian  tube. 

Q.  Where  is  the  Eustachian  opening? 

A.  It  lies  above  the  palate  (uvula),  while  the 
second  cleft  remains  lower  down,  and  lies  below  the 
palate  as  the  anlage  of  the  tonsil. 

Q.  At  what  time  does  the  uvula  appear? 

A.  During  the  latter  half  of  the  third  month,  as  a 
projective  of  the  border  of  the  soft  palate. 

Q.  At  what  time  does  the  nasal  septum  unite? 

A.  Soon  after  the  two  palate  shelves  have  united; 


ON  IRREGULARITIES  OF  THE  TEETH. 


211 


thereby  the  permanent  or  adult  relations  of  the  cav¬ 
ities  are  established. 

O.  What  are  the  views  of  Beaunis  and  Bouchard  in 
regard  to  the  development  of  the  mouth  and  surround¬ 
ing  parts? 

A.  “Beginning  of  third  week  —  first  pharyngeal 
arch;  buccal  depression.  End  of  third  week — coales¬ 
cence  of  the  inferior  maxillary  protuberances;  forma¬ 
tion  of  the  three  last  pharyngeal  arches.  Fourth  week — 
olfactory  fossae.  Fifth  week — ossification  of  lower  jaw. 
Sixth  week — the  pharyngeal  clefts  disappear,  the 
tongue,  the  larynx,  and  germs  of  teeth.  Seventh 
week — points  of  ossification  of  intermaxillary  bone; 
.palate  and  upper  jaw  (its  first  four  points).  Eighth 
week — the  two  halves  of  the  bony  plate  unite.  Ninth 
week — osseous  nuclei  of  vomer  and  malar  bone;  the 
union  of  the  hard  palate  is  completed.  Third  month — 
points  of  ossification  for  the  sphenoid  and  nasal  bones; 
squamous  portion  of  temporal  orbital  center  of 
superior  maxillary  bone;  commencement  of  formation 
of  maxillary  sinus;  epiglottis.  Fifth  month — osseous 
points  of  lateral  masses  of  ethmoid;  ossification  of 
germs  of  teeth;  appearance  of  germs  of  permanent 
teeth.  ’’ 

Q.  What  may  occur  at  the  fifth  month  from  mal¬ 
nutrition? 

A.  At  or  about  this  time  is  the  first  period  of  stress. 
As  a  result  of  hereditary  defect  or  mal-nutrition,  arrest 
of  development  may  check  the  growth  of  tissue  and 
the  various  types  of  degeneracy  result. 

Q.  Is  cleft  palate  common? 

•A.  It  is  comparatively  rare  in  proportion  to  other 
forms  of  nutritive  degeneracies. 


212 


QUIZ  COMPEND 


•  Q.  Is  palate  embryology  a  good  study  for  certain 
symptoms? 

A.  It  throws  certain  light  on  etiology  and  prognosis. 

Q.  What  points  may  be  derived? 

A.  Since  most  cleft  palates  occur  in  defective  indi¬ 
viduals,  and  since  cleft  palate  predisposes  to  death  by 
infectious  disease,  whose  local  manifestations  are  in 
the  mouth  and  throat,  those  in  whom  cleft  palate  most 
occurs  are  liable  to  die  before  the  completement  of 
the  sixth  year. 

Q.  Was  cleft  palate  early  associated  with  other 
defects. 

A.  Early  in  the  nineteenth  century.  Tiedmann 
noticed  that  in  certain  cases  of  cleft  palate  the  olfactory 
nerve  was  absent  or  abnormal.  He  concluded,  there¬ 
fore,  the  deformity  was  resultant  upon  atrophy  of  the 
nerve  origin  of  the  olfactory  organ.  M.  J.  Weber, 
after  a  careful  analysis  of  all  accessible  cases,  failed  to 
find  one  in  which  the  olfactory  nerve  was  absent. 

Q.  What  conclusions  may  be  drawn  at  the  present 
time? 

A.  Coincidence  of  cleft  palate  and  olfactory  nerve 
atrophy  discovered  by  Tiedmann  probably  result  from 
the  same  central  mal-development.  They  bear  no 
causal  relation  to  each  other. 

Q.  When  coalescence  of  structure  fails  to  occur, 
what  takes  place? 

A.  Certain  deformities  are  produced,  chief  of 
which  are  cleft  palate  and  hare-lip. 

Q.  Does  this  condition  run  in  families? 

A.  According  to  Bland  Sutton  it  has  been  known  to 
appear  in  several  members  of  the  same  family,  and 
to  occur  in  the  offspring  of  affected  members. 


ON  IRREGULARITIES  OF  THE  TEETH. 


213 


Q.  Is  cleft  palate  ever  observed  in  animals? 

A.  Instances  of  the  transmission  of  this  deformity 
have  been  traced  from  an  affected  pug  bitch  to  her 
offspring. 

Q.  Could  a  race  of  men,  with  hare-lip  and  cleft 
palate,  be  produced? 

A.  There  is  no  question  that  if  it  were  possible  to 
practice  selective  breeding  in  man,  as  in  dogs,  such  a 

i 

race  could  be  produced. 

Q.  What  relation  between  brain  and  cleft  palate 
has  been  claimed? 

A.  That  cleft  palate  results  from  excessive  devel¬ 
opment  of  the  anterior  portion  of  the  brain  and  skull, 
such  as  produces  hernia  cerebri,  ventricular  atrophy, 
or  excessive  anterior  cerebral  lobe  development. 

Q.  Does  this  theory  hold  good? 

A.  This  mixed  patho-teratologic  theory  is  not  war- 
•  ranted  by  either  embryology  or  clinical  observa¬ 
tion. 

Q.  What  is  Langdon  Down’s  theory  in  regard  to 
cleft  palates? 

A.  He  found  a  constant  relation  between  brain 
deformity,  cleft  palate,  and  deformed  vaults,  and  sug¬ 
gests  that  “it 'is  possible  that  it  may  arise,  as  has  been 
suggested,  from  sphenoid,  arrest  of  development,  or 
vomer  defects  in  development.” 

Q.  What  has  been  shown  on  the  other  side? 

A.  It  has  been  plausibly  shown  that  the  contracted 
high  vault  is  not  due  to  the  condition,  and  there  can 
be  no  relation  between  contracted  vaults  and  cleft 
palates.  The  cleft  occurs  before  the  tenth  week  of 
foetal  life,  while  the  contracted  vault  does  not  appear 
until  after  the  sixth  year. 


214 


QUIZ  COMPEND 


Q.  Are  cleft  palates  becoming  more  frequent  dur¬ 
ing  the  present  century? 

A.  This  opinion  was  supported  by  Oakley  Coles  on 
the  ground  that  palatal  vault  deformities  are  more 
frequent,  and  that  a  relation  exists  between  them  and 
cleft  palate.  The  relation  between  a  high  state  of 
civilization  and  a  high  proportion  of  palatal  deform¬ 
ities  is  something  more  than  a  mere  matter  of  consid¬ 
eration. 

Q.  What  error  did  Coles  make? 

A.  In  dealing  with  the  influence  of  civilization  he 
ignored  all  but  its  degenerative  influences.  Under 
civilization  the  defective  classes  are  preserved ;  further¬ 
more,  this  preservation  extends  particularly  to  those 
under  five  years  of  age,  who  would  be  destroyed 
under  primitive  conditions. 

Q.  How  may  cleft  palates  be  divided? 

A.  Into  two  classes,  congenital  and  acquired. 

Q.  What  is  meant  by  congenital? 

A.  That  it  existed  at  birth. 

Q.  What  is  acquired  cleft  palate? 

A.  The  result  of  disease. 

Q.  How  is  congenital  cleft  palate  divided? 

A.  Into  two  kinds,  complete  and  partial. 

Q.  What  is  complete  cleft  palate? 

A.  Here  the  fissure  extends  the  entire  length  from 
the  uvula  to  and  including  the  anterior  alveolar  pro¬ 
cess  and  lip.  It  is  partial  when  only  a  part  of  the 
structures  are  involved, 

Q.  May  only  the  anterior  part  be  involved? 

A.  The  cleft  may  extend  through  the  anterior 
alveolar  process,  involving  only  the  incisive  bones, 


ON  IRREGULARITIES  OF  THE  TEETH. 


215 


which  is  very  rare ;  when  present,  single  or  double 
hare-lip  almost  invariably  exists. 

Q.  What  other  deformities  occur? 

A.  Cases  occur  where  only  a  small  part  of  the  an¬ 
terior  alveolar  process  and  jaw  are  involved,  together 
with  one  or  two  teeth.  The  hard  palate  may  be  in¬ 
volved  to  the  extent  of  a  small  fissure,  or  the  whole 
bone  may  be  wanting.  The  soft  palate  may  only 
contain  the  cleft  or  simply  the  uvula.  Cases  are  on 
record  in  which  the  non-development  of  the  maxillary 
bones  produces  fissures  in  the  lip. 

Q.  Is  cleft  palate  inherited? 

A.  The  view  expressed  by  Bland  Sutton  and  Oak¬ 
ley  Coles  would  lead  to  that  conclusion.  Sufficient 
data  have  not  been  forthcoming  to  show  that  the 
actual  presence  of  the  deformity  in  the  parent  has  had 
a  direct  predisposing  influence  upon  the  child. 

Q.  Could  maternal  mental  impression  cause  the 
deformity? 

A.  It  may  be  confidently  stated  the  deformity 
cannot  be  produced  from  any  impression  received  by 
the  mother  during  pregnancy. 

O.  What  are  the  chances  of  inheritance  of  cleft 
palate? 

A.  In  most  cases  which  have  come  immediately 
under  notice,  when  one  of  the  parents  had  cleft  palate 
all  the  children  have  been  born  perfectly  developed, 
even  though  dread  of  transmitting  the  deformity  was 
always  present  in  the  mind  of  the  mother.  In  one 
case,  curiously  enough,  there  were  three  members  of 
one  family  with  cleft  palate,  one  seventeen  years  of 
age,  one  thirty,  and  one  thirty-five.  The  first  and 
last  are  ladies,  the  other  a  gentleman,  who  is  mar- 


216 


QUIZ  COMPEND 


ried,  and  has  a  family  without  the  father’s  de¬ 
fect. 

Q.  Was  there  any  trace  of  cleft  palate  in  the 
ancestor? 

A.  No  defect  could  be  found  either  among  the 
ancestors  or  collateral  branches  of  the  family. 

Q.  Are  there  evidences  of  inherited  cleft  palate? 

A.  Another  family  has  the  following  remarkable 
history:  G.  H.  C.,  born  1853,  perfect.  L.  C.,  born 

1855,  single  hare-lip  and  cleft  palate.  J.  F.  C.,  born 

1856,  perfect.  F.  W.  C.,  born  i860,  double  hare-lip 
and  cleft  palate.  H.  E.  C.,  born  1863,  perfect.  The 
paternal  grandmother  likewise  had  cleft  palate. 

Q.  What  is  the  percentage  among  degenerates? 

A,  Knecht  found  five  per  cent,  of  1,200  criminals 
examined  to  have  cleft  palates,  and  fourteen  per  cent, 
of  the  prostitutes  examined  by  Pauline  Tarnowsky 
had  cleft  palates.  Langdon  Down,  among  congen¬ 
ital  idiots,  found  only  half  a  per  cent,  of  cleft  palates. 
Grenser  found  nine  cases  in  14,466  children,  or  one  in 
1,607.  Talbot  examined  1,977  feeble-minded  children 
without  finding  a  single  case.  In  207  blind  but  one 
case  was  observed.  In  1,935  deaf  mutes,  two  cases, 
or  about  one  in  1,000.  The  percentage  among  the 
defective  classes  is  undoubtedly  much  larger  than 
among  normal  individuals,  but  early  deaths  explain 
the  small  numbers. 

Q.  What  is  the  history  among  animals? 

A  Ogle  found  that  ninety-nine  per  cent,  of  the 
lion  cubs  born  in  the  London  Zoological  Gardens  had 
cleft  palates.  This  he  ascribes  to  the  artificial  diet 
as  the  result  of  enforced  captivity.  Similar  results 
in  other  gardens  in  Europe  were  charged  to  feeding 


ON  IRREGULARITIES  OF  THE  TEETH. 


217 


the  m’other  with  meat  without  bone,  since  feeding 
with  the  whole  carcass  of  small  animals  greatly 
diminished  these  deformities.  If  cleft  palate  were 
sometimes  attributable  to  this  cause,  other  bony 
structures  should  likewise  be  involved.  It  is,  hence, 
not  astonishing  to  find  many  lions  in  captivity  were 
rickety.  Cleft  palate  has  been  observed  among  dogs, 
sheep,  goats,  etc.  The  question,  however,  whether 
domesticity  does  not  play  in  them  the  alleged  part  of 
civilization  in  man  can  be  solved  only  by  knowledge  of 
the  frequency  of  the  condition  among  wild  animals  of 
the  same  family. 

Q.  In  dealing  with  etiology  what  must  be  taken 
into  consideration? 

A.  The  influence  of  shock  on  the  mother’s  nervous 
system  cannot  be  excluded  in  the  cases  charged  to 
feeding. 


CHAPTER  XXV. 


DEVELOPMENTAL  NEUROSES  IN  TEETH  POSITION. 

Q.  Are  the  jaws  subject  to  arrest  of  development? 

A.  They  are. 

Q.  Why? 

A.  They  are  transitory  structures. 

Q.  Do  periods  of  stress  affect  both  jaws  alike? 

A.  They  do  not. 

Q.  Which  is  the  most  subject  to  deformity? 

A.  The  upper. 

Q.  Why? 

A.  Because  it  is  a  fixed  bone,  and  influenced  by 
other  bones  of  the  head. 

Q.  How  do  the  periods  of  stress  affect  the  jaw? 

A.  They  cause  excessive  and  arrest  of  develop¬ 
ment. 

Q.  Why  do  they  produce  both? 

A.  Because  of  the  law  of  economy  of  growth,  which 
causes  gain  in  one  direction  at  the  expense  of  another. 

Q.  What  deformities  are  produced? 

A.  V  and  saddle  shaped  dental  arches. 

Q.  What  local  condition  produces  the  same  results? 

A.  Premature  extraction  of  the  temporary  teeth, 
thus  allowing  the  first  permanent  molars  to  move  for¬ 
ward  and  to  diminish  the  space,  thus  causing  tooth 
irregularities. 

Q.  What  structures  are  involved  in  these  deform¬ 
ities? 

A.  The  structures  involved  in  the  formation  of 


219 


220 


QUIZ  COMPEND 


these  deformities  are  the  jaws  and  alveolar  process  on 
one  hand  and  teeth  on  the  other. 

Q.  What  is  the  nature  of  these  structures? 

A.  The  alveolar  process  is  soft  and  yielding,  while 
the  jaws  and  teeth  are  composed  of  hard,  dense  sub¬ 
stances.  The  alveolar  process  adapts  itself  to  the 
teeth,  no  matter  what  position  they  take. 

Q.  What  constitutes  the  dental  arch? 

A.  All  the  teeth  when  in  position. 

Q.  Do  the  teeth  upon  both  sides  of  the  jaw  depend 
upon  each  other? 

A.  They  do  not.  The  jaws  and  teeth,  like  the 
lateral  halves  of  the  body,  develop  independent  of 
each  other.  Each  possesses  its  own  peculiar  charac¬ 
teristics  as  regards  irregularities  of  the  teeth. 

Q.  How  can  the  classification  of  irregularities  be 
simplified? 

A.  By  dividing  each  jaw  at  the  median  line  into 
right  and  left  superior,  right  and  left  inferior  dental 
arches. 

Q.  Is  such  classification  strictly  correct  from  an 
architectural  point  of  view? 

A.  It  is  not,  but  for  clinical  purposes  it  is  admirably 
adapted. 

Q.  To  what  is  the  construction  of  these  deform¬ 
ities  comparable? 

A.  To  the  construction  of  an  arch,  each  tooth  rep¬ 
resenting  a  stone. 

Q.  Are  development  of  the  teeth  and  these  peculiar 
formations  purely  mechanical? 

A.  The  time  and  movement  of  the  teeth  determine 
the  chaiacter  of  the  deformity,  just  as  in  chess  or 
checkers,  time  and  movement  determine  the  result. 


ON  IRREGULARITIES  OF  THE  TEETH 


221 


Q.  What  does  each  lateral  arch  contain? 

A.  It  contains  teeth  which  correspond  to  the  stones 
of  an  arch. 

Q.  How  are  these  stones  laid? 

A.  Their  laying  depends  on  the  time  of  normal 
eruption  of  teeth. 

O.  Build  a  normal  lateral  arch. 

A.  The  first  stone  laid  will  correspond  to  the  first 
permanent  molar,  and  is  called  the  “posterior  base.” 
The  next  stone  laid  is  the  central  incisor,  and  is  called 
the  “anterior  base.”  The  next  stone  is  located 
upon  the  anterior  base  and  corresponds  to  the 
lateral  incisor.  The  next  stones  are  the  first  and 
second  bicuspids,  and  are  laid  upon  the  posterior  base. 
The  stone  corresponding  to  the  first  bicuspid  is  usually 
in  position  first,  but  sometimes  the  stone  correspond¬ 
ing  to  the  second  bicuspid  is  placed  first.  To  complete 
the  arch  it  is  necessary  to  place  the  keystone  in  posi¬ 
tion — the  cuspid.  If  the  stones  have  been  properly 
proportioned  and  measurement  correct,  the  keystone 
will  fit  into  its  proper  place,  and  the  arch  will  be  com¬ 
pleted.  On  examining  the  posterior  foundation  two 
more  stones  are  found,  these  correspond  to  the  second 
and  third  molars.  These  stones  beneath  the  base  and 
the  stones  above  the  base  make  a  very  strong  abut¬ 
ment. 

Q.  What  constitutes  a  normal  dental  arch? 

A.  There  are  three  characteristics  of  a  normal 
dental  arch.  Independent  of  temperament  pecul¬ 
iarity,  the  lines  extending  from  one  cuspid  to  another 
should  be  the  arc  of  a  circle,  not  an  angle  or  straight 

line;  the  line  from  cuspids  to  the  third  molars  should 

18 


222 


QUIZ  COMPEND 


be  straight,  curving  neither  in  nor  out,  the  sides  not 
approximating  parallel  lines. 

Q.  Should  both  sides  be  alike? 

A.  Absolute  bilateral  uniformity  is  not  implied, 
since  the  two  halves  of  the  human  jaw  are  rarely  if 
ever  alike. 

Q.  What  does  a  uniform  arch  necessitate? 

A.  Uniformity  of  development  between  the  arch 
of  the  maxilla  and  the  arch  of  the  teeth,  and  a  correct 
relation  of  the  individual  teeth  to  each  other. 

Q.  What  must  occur  when  disharmony  results  from 
inheritance  of  the  small  jaw  of  one  parent  and  the 
large  teeth  of  the  other? 

A.  Irregularities. 

Q.  What  are  these  called? 

A.  Constitutional  irregularities. 

Q.  When  there  is  a  difference  in  the  diameter  what 
takes  place? 

A.  The  line  formed  by  the  teeth  must  either  fall 
outside  or  within  the  arch  of  the  maxilla,  and  irregu¬ 
larities  of  a  grave  nature  must  result. 

Q.  What  happens  in  the  construction  of  an  arch  if 
the  diameter  of  the  stones  be  too  small  for  the  curve 
on  the  bases,  or  be  set  too  far  apart? 

A.  The  keystone  will  not  find  support,  and  will 
drop  through  toward  the  center. 

Q.  Is  this  very  common? 

A.  Yes.  The  cuspid  points  into  the  vault,  or 
remains  imbedded  in  the  jaw. 

Q.  Suppose  the  arch  be  too  small,  or  the  posterior 
base  and  foundation  stones  have  been  brought  forward 
to  the  extent  that  there  is  no  room  for  the  keystone, 
what  happens? 


ON  IRREGULARITIES  OF  THE  TEETH. 


223 


A.  The  keystone  remains  outside  the  arch. 

Q.  What  happens  if  the  arch  be  partly  or  wholly 
closed  and  the  keystone  be  very  heavy  (has  great  lev¬ 
erage)  ? 

A.  The  keystone  will  force  the  foundation  or  break 
the  arch  or  both.  The  posterior  base,  with  founda¬ 
tion,  being  so  strong,  it  resists  the  force.  The  anterior 
base  being  weak,  and  without  support,  bulges  out, 
and  in  this  way  the  semi-V  arch  is  produced. 

O.  How  is  the  V  arch  produced? 

A.  The  posterior  base  is  seldom,  if  ever,  carried 
backwards,  owing  to  the  number  of  roots  upon  each 
tooth,  and  the  broad,  thick  alveolar  process  to  hold 
them.  The  anterior  teeth  all  have  round  single  roots, 
and  are  located  in  a  thin  alveolar  process,  easily  bent 
out  of  position.  The  keystones,  coming  into  place, 
crowd  against  the  posterior  base  and  carry  the  anterior 
bases  and  teeth  forward,  thus  producing  the  V-shaped 
arch. 

O.  How  many  teeth  are  involved  in  the  construc¬ 
tion  of  the  V-shaped  arch  and  its  modifications? 

A.  The  ten  anterior  teeth.  These  teeth  are  all 
wedge-shape;  the  bases  being  thin  cutting  edges,  and 
the  apices  at  the  end  of  the  roots.  They  are  also 
nearly  round  and  conical,  the  points  of  antagonism 
being  nearly  or  quite  at  the  cutting  edges. 

Q.  Do  these  approximate  surfaces  assist  in  produc¬ 
ing  irregularities  of  the  teeth? 

A.  They  constitute  the  fulcrum  of  the  lever,  which, 
when  force  is  applied  to  the  teeth,  causes  them  to 
rotate  and  move  out  of  position,  thus  producing  more 
varieties  of  deformities  than  it  is  possible  to  demon¬ 
strate  upon  the  stone  arch. 


I 


224  QUIZ  COMPEND 

Q.  How  is  the  germ  of  the  cuspid  located  in  rela¬ 
tion  to  the  other  germs  in  the  jaw? 

A.  It  is  outward  and  above  on  a  line  of  a  larger 
circle. 

Q.  How  does  its  root  compare  with  that  of  the 
other  teeth? 

A.  It  is  much  longer. 

Q.  What  results  in  eruption  from  this  position  and 
length  of  root? 

A.  It  is  the  most  powerful  tooth.  Downward  and 
inward  movement,  together  with  some  pressure  from 
the  lips,  will  cause  it  to  descend  until  it  meets  obstruc¬ 
tion  great  enough  to  resist  further  descent,  locking 
the  arch  and  holding  the  teeth  in  the  proper  posi¬ 
tion. 

Q.  Where  does  the  break  occur  when  the  cuspids 
come  into  place  and  there  is  not  sufficient  room? 

A.  Always  at  the  weakest  point, 

Q.  Where  is  this  naturally? 

A.  Anterior  to  the  cuspid  teeth. 

Q.  Does  the  break  always  take  place  at  the  one 
locality? 

A.  No.  The  break  depends  upon  the  weakness  of 
the  part  and  the  position  of  the  anterior  teeth.  It 
may  be  between  the  centrals,  centrals  and  laterals, 
laterals  and  cuspids. 

Q.  Do  teeth  always  take  the  same  position? 

A.  They  do  not.  They  may  point  outward  or  in, 
thus  modifying  the  shape  of  the  V. 

Q.  Are  two  deformities  absolutely  alike? 

A.  Although  it  is  claimed  that  these  deformities 
are  a  direct  inheritance,  and  therefore  alike,  this  is 
not  the  case.  They  are  never  directly  inherited,  and 


ON  IRREGULARITIES  OF  THE  TEETH. 


225 


because  they  depend  o*n  mechanical  environment  they 
are  never  absolutely  alike. 

Q ,  What  is  a  partial  V-shaped  arch? 

A.  When  a  line  is  drawn  through  the  vault  and  the 
median  line,  if  the  incisors  do  not  come  to  a  point,  in 
other  words,  if  the  anterior  arches  about  half  way 
between  a  V  and  normal,  it  is  a  partial  V-shaped  arch. 

Q.  What  is  a  semi-V-shaped  arch? 

A.  It  is  one  where  one  side  is  V-shaped,  and  the 
other  normal  or  nearly  so. 

Q.  Does  the  lower  jaw  ever  assume  a  V-shaped 
arch? 

A.  Never  when  the  teeth  of  both  jaws  articulate 
normally. 

Q.  Why? 

A.  Because  the  anterior  inferior  teeth  close  inside 
of  the  upper,  and  forward  movement  is  thus  prevented. 

Q.  Should  the  inferior  dental  arch  be  divided  like 
the  other? 

A.  Yes.  It  should  be  divided  into  right  and  left, 
like  the  upper,  because  the  forward  movement  of  the 
posterior  column  and  the  eruption  of  the  cuspid  exert 
the  same  influence  as  on  the  upper.  Each  lateral  half 
has  its  bases  and  keystone. 

Q.  Is  the  break  in  the  arch  the  same? 

A.  It  is  not,  because  the  anterior  base  (the  central 
incisors)  is  held  in  position  by  the  superior  incisors, 
and  the  break  usually  takes  place  at  the  cuspid  teeth. 
The  cuspids  are  carried  forward. 

Q.  Are  the  upper  incisors  sometimes  carried  for¬ 
ward? 

A.  Yes.  Sometimes  the  superior  alveolar  process 
is  very  weak,  and  the  anterior  force  of  the  lower  jaw 


226 


QUIZ  COMPEND 


is  very  great ;  in  such  cases  the  superior  incisors  are  car¬ 
ried  forward  and  spaces  will  appear  between  the  teeth. 

Q.  Are  saddle-shaped  arches  as  common  as  the 
V-shaped? 

A.  No. 

Q.  Have  they  properties  common  to  the  V-shaped 
arch? 

A.  They  have  many. 

Q.  Name  some. 

A.  They  may  include  one  or  both  lateral  arches. 
They  may  be  partial  on  one  side  and  normal  on  the 
other.  Each  lateral  arch  produces  its  own  deformity 
independent  of  the  other.  The  vault  may  be  high  or 
low.  The  deformity,  like  the  V-shaped,  is  favored  by 
the  high  arch. 

Q.  How  is  the  saddle-shaped  arch  produced? 

A.  Like  the  V-shaped,  there  is  the  right  and  left 
lateral  arches  of  stone.  Each  stone  corresponds  in  size 
and  location  to  the  natural  teeth.  The  first  stone  laid 
in  the  arch  corresponds  to  the  first  permanent  molar, 
and  like  the  stone  in  the  V-shaped  arch,  is  denominated 
the  posterior  base.  The  next  stone  laid  corresponds 
to  the  central  incisors,  then  the  stone  which  stands  for 
the  lateral  incisor.  The  natural  order  now  changes, 
and  the  next  stone  laid  corresponds  to  the  keystone  of 
the  V-shaped  arch  —  the  cuspid.  This  stone  (the 
cuspid)  forms  the  fixed  anterior  base,  and  is  backed 
by  the  central  and  lateral  teeth.  The  next  stone  laid 
'corresponds  to  the  first  bicuspid,  followed  by  those 
representing  the  second  bicuspids  and  the  second  and 
third  molars.  The  stones  being  in  position,  the  anterior 
and  posterior  columns  are  nearly  equal  in  strength 
and  resisting  power. 


I 


1 


227 


ON  IRREGULARITIES  OF  THE  TEETH. 

Q.  Does  forward  movement  of  the  posterior  col¬ 
umn  take  place  under  the  same  local  conditions  as  in 
the  V-shaped  arch? 

A.  In  precisely  the  same  manner. 

Q.  Does  the  keystone  (the  cuspid)  play  the  same 
part  here? 

A.  It  does  not,  it  is  now  a  fixture. 

O.  Which  are  the  weakest  stones  in  this  arch? 

A.  They  correspond  to  the  bicuspids,  and  are  the 
stones  which  are  always  displaced  when  the  forward 
movement  of  the  posterior  column  occurs. 

Q.  Does  this  account  for  existence  of  fewer  saddle 
arches  than  V-shaped? 

A.  Yes.  The  change  in  the  anterior  base  also 
accounts  for  the  fact  that  the  anterior  teeth  do  not 
protrude  in  the  saddle  arch,  while  they  always  do  in 
the  V-shaped  arch. 

Q.  What  great  factors  assist  in  the  development  of 
the  saddle  arch? 

A.  The  shapes  and  points  of  contact  of  the  indi¬ 
vidual  teeth.  Their  Surfaces  are  not  flat,  but  rounded, 
while  the  surface  of  the  first  permanent  molar  is  an 
incline  with  the  decline  inward. 

Q.  Why  are  the  bicuspids  not  carried  outward  as 
well  as  inward? 

A.  They  are  occasionally,  but  their  eruption  and 
environment  are  favorable  to  the  inward  movement, 
which  is  the  natural  case. 

Q.  Are  there  other  reasons  for  inward  movement? 

A.  Yes.  The  crowns  of  the. bicuspids  are  situated 
between  the  roots  of  the  temporary  teeth,  where  the 
first  permanent  molar  erupts.  It  develops  outside  and 
on  a  larger  circle  than  the  temporary  set.  When  the 


228 


QUIZ  COMPEND 


temporary  molar  is  extracted,  the  first  permanent 
molar  moves  forward,  and  the  incline  holds  the  crown 
of  the  second  bicuspid  from  taking  the  larger  circle. 

Q.  Having  explained  the  local  conditions,  describe 
the  method  of  formation  of  the  saddle  arches. 

A.  The  anterior  and  posterior  bases  being  in  place, 
the  stones  corresponding  to  the  first  and  second,  bicus¬ 
pids  being  on  a  smaller  circle,  the  posterior  column 
moves  forward,  crowding  the  two  teeth  against  the 
anterior  base,  both  bases  inclining  inwards,  carries  the 
bicuspid  inwards.  This  lateral  movement  continues 
until  the  teeth  are  locked  tightly  together. 

Q.  How  is  the  partial  saddle  arch  formed? 

A.  If  the  locking  of  the  arch  takes  place  between 
the  cuspid  and  molar,  the  bicuspids  are  carried  in  a 
great  distance  and  a  partial  saddle-arch  is  formed. 

Q.  What  is  the  semi-saddle  arch? 

A.  It  is  an  arch  where  the  deformity  is  only  on 
one  side. 

Q.  Is  a  bicuspid  occasionally  carried  into  the  vault? 

A.  Yes.  Usually  the  second.  The  second  tem¬ 
porary  molar  holds  the  bicuspid  on  a  smaller  circle 
until  all  the  other  teeth  are  in  place.  When  this  is 
removed,  the  inclination  of  the  crown  is  inward,  the 
first  permanent  molar  moves  forward,  and  the  incline 
pushes  the  bicuspid  into  the  vault.  The  first  molar 
continues  its  forward  movement  until  it  touches  the 
first  bicuspid,  thus  closing  the  arch. 

Q.  How  may  a  V-shaped  and  saddle  arch  be  com¬ 
bined  upon  one  side? 

JL 

A.  Given  a  thin  alveolar  process,  early  or  late  ex¬ 
traction  of  the  temporary  molars,  the  posterior  column 
moves  forward,  carrying  the  bicuspids  inward.  The 


ON  IRREGULARITIES  OF  THE  TEETH. 


229 


cuspid  comes  down  and  from  want  of  room  the 
incisors  are  carried  forward,  the  V-shaped  arch  will  be 
developed  forward,  and  the  saddle  arch  at  the  side. 

Q.  What  shape  will  the  opposite  side  take? 

A.  It  may  be  a  V-shaped,  saddle,  or  normal,  de¬ 
pending  upon  the  manner  of  eruption  of  the  teeth  and 
the  amount  of  room  provided  for  them. 

Q.  Does  the  saddle  arch  occur  upon  the  lower  jaw? 

A.  Saddle  arches  are  observable  upon  the  lower 
jaw.  They  form  in  the  same  manner  as  upon  the  upper. 
The  force  of  the  posterior  column  is  often  so  great  that 
the  anterior  base,  the  cuspid,  is  carried  forward  over 
the  side  of  the  arch.  The  laterals  are  carried  inward. 

Q.  In  a  general  way  what  do  these  two  forms 
resemble? 

A.  Both  are  atavistic.  The  V-shape  reverts  to  the 
reptilian  type  of  jaw,  while  the  saddle  arch  reverts 
to  the  carnivora. 

Q.  Are  these  deformities  in  perfect  harmony  with 
the  laws  of  evolution? 

A.  They  are.  Given  a  small  jaw,  the  order  of  erup¬ 
tion  of  the  teeth  could  not  produce  other  than  these 
two  types  of  jaws  or  their  modifications. 


’ 

■ 


- 


CHAPTER  XXVI. 


LOCAL  CAUSES  OF  TEETH  IRREGULARITIES— 

UPPER  JAW. 

Q.  How  are  local  irregularities  formed? 

A.  In  malposition  and  malocclusion  of  individual 
teeth,  as  a  result  of  an  accident  (such  as  premature  or 
tardy  extraction  of  the  temporary  teeth)  or  malposition 
and  malocclusion  resultant  on  constitutional  causes. 

Q.  What  is  the  principal  cause? 

A.  Relative  position  of  the  first  permanent  molar. 

Q.  How  does  it  affect  the  position  of  the  teeth? 

A.  If  the  temporary  molars  be  extracted  prema¬ 
turely,  the  forward  movement  of  the  posterior  column 
follows.  The  teeth  in  the  anterior  column  are  more 
or  less  influenced  by  vicious  position,  relation  and 
occlusion. 

Q.  Are  temporary  teeth  moved  forward  by  the 
permanent  molars? 

A.  Sometimes.  Even  the  permanent  cuspids  at 
times  yield. 

Q.  What  tooth  is  next  in  importance  as  to  vicious 
influence? 

A.  The  cuspid.  It  asserts  itself  above  the  rest 
because  of  its  vital  force, length  of  root,  peculiar  shape 
and  location  in  the  jaw.  The  length  of  its  root  allows 
it  to  deviate  most  of  any  teeth  from  its  original  posij 
tion. 

Q,  Which  is  next? 


231 


2&2 


QUIZ  COMPEND 


A.  The  central  incisor  comes  next  in  importance 
while  the  lateral  is  the  most  passive  of  teeth. 

Q.  Why? 

A.  Because  it  is  the  smallest  and  situated  be¬ 
tween  the  two  strongest  in  the  anterior  part  of  the 
mouth. 

Q.  Is  it  very  easily  displaced? 

A.  Yes.  Because  of  its  weakness  and  short, 
round  root. 

Q.  What  effect  has  the  forward  movement  of  the 
posterior  column  forcing  the  anterior  column  forward? 

A.  Pressure  brought  to  bear  upon  both  sides 
makes  the  arch  of  the  upper  maxilla  greater  than  the 
lower. 

Q.  What  effect  does  that  produce? 

A.  The  result  is  that  occlusion  is  wanting  or 
defective,  and  flexion  must  take  place  according  to 
position  assumed  in  the  eruption  of  each  individual 
tooth. 

Q.  Does  the  cuspid  exert  much  influence? 

A.  The  force  of  the  cuspid  is  spent  upon  the 
incisor. 

Q.  Are  the  incisors  quite  large? 

A.  They  are  at  times  owing  to  inheritance  or 
vigorous  growth. 

Q.  Do  they  then  exert  more  influence? 

A.  They  do;  not  so  much  in  relation  to  position 
of  the  axes  as  in  irregularities  of  the  cutting  edges. 
These  from  the  excessive  diameter  overlap. 

Q.  Do  the  temporary  incisors  when  retained  too 
long  produce  irregularities? 

A.  If  retained  too  long  the  permanent  tooth  is  em¬ 
barrassed  in  its  eruption.  It  seeks  its  way  out  as  best  it 


ON  IRREGULARITIES  OF  THE  TEETH. 


233 


can  and  as  erupting  in  straight  lines  is  out  the  ques¬ 
tion,  it  slips  around  the  root  of  the  temporary  tooth 
and  is  thus  forced  out'  of  position. 

Q.  Are  not  all  anterior  teeth  influenced  more  or 
less  in  this  way  when  temporary  teeth  remain  too 
long? 

A.  Yes.  Great  care  should  be  exercised  in  remov¬ 
ing  the  temporary  teeth  at  the  proper  period. 

Q.  What  is  the  most  common  form  of  irregulari¬ 
ties  connected  with  the  central  incisor? 

A.  That  found  in  connection  with  the  V-shaped 
arch.  The  force  is  applied  from  behind,  the  mesial 
edges  touch  and  the  teeth  revolve  upon  their  axis,  the 
cutting  edges  are  not  in  line  but  form  an  angle  and 
point  forward. 

Q.  Is  not  this  the  most  natural  form  for  the  flex¬ 
ion  to  assume? 

A.  It  is.  The  arch  is  simply  broken  in,  its  weak¬ 
est  point  following  the  general  direction  of  the  presT 
sure. 

Q.  Do  these  teeth  ever  overlap? 

A.  It  is  a  very  common  deformity.  The  edge 
being  round  sometimes  the  force  in  both  directions  is 
not  alike,  in  which  case  one  incisor  is  carried  a  little 
forward  this  causing  the  teeth  to  lap. 

Q.  What  other  forms  of  deformity  do  the  incisor 
teeth  assume? 

A.  When  the  cutting  edges  form  an  angle  which 
is  directed  backward  the  pressure  is  from  behind  as  in 
the  other  variety  of  deformities. 

Q.  What  forms  do  the  laterals? 

A.  When  the  cuspids  come  into  place  they  crowd 
the  laterals  forward.  It  depends  upon  the  occlusion 


234 


QUIZ  COMPEND 


with  the  centrals  whether  they  remain  in  position  or 
whether  they  pass  in  front  or  behind  the  centrals. 

Q.  What  different  positions  are  assumed  by  the 
laterals? 

A.  i.  Mesial  surface  of  lateral  overlapping  distal 
surface  of  central,  while  distal  surface  is  in  a  line 
with  cuspid. 

2.  Mesial  surface  of  lateral  overlapping  distal  sur¬ 
face  of  central,  while  distal  surface  is  behind  the 
cuspid. 

3.  Mesial  surface  of  lateral  behind  the  distal  sur¬ 
face  of  the  central,  while  the  distal  surface  is  in  a  line 
with  the  cuspid. 

4.  Lateial  in  a  line  anterior  to  that  of  central  and 
cuspid. 

5.  Lateral  in  a  line  posterior  to  central  and 
cuspid. 

6.  Lateral  at  light  angles  with  the  line  of  the  in¬ 
cisor  and  cuspid. 

7*  Lateral  wholly  inside  the  arch. 

Q.  Is  the  lateral  often  out  of  normal  position? 

A.  The  lateral  is  more  frequently  out  of  position 
than  any  other  tooth  because  it  is  the  weakest  in  the 
arch  and  has  the  shortest  root. 

Q.  Upon  what  does  its  position  depend? 

A.  Upon  the  environment  of  its  own  side  of  the 
arch,  independently  of  the  other. 

Q.  Besides  its  weakness,  what  also  produces 
change  of  position? 

A.  First,  shortness  and  conical  shape  of  its  root. 
Second,  its  wedge  shape  crown.  The  shortness  of  its 
root,  together  with  its  conical  outline,  causes  it  to  be 
more  easily  impinged  upon  by  the  root  of  the  incisor 


ON  IRREGULARITIES  OF  THE  TEETH. 


235 


which  will  produce  partial  rotation.  The  wedge  shape 
of  its  crown  facilitates  rotation. 

Q.  What  results  when  diameter  of  cutting  edge  is 
greater  than  that  of  the  root? 

A.  The  greater  the  degree  of  rotation  must  be 
before  the  lateral  finds  a  resting  place. 

Q.  Are  the  laterals  found  wholly  inside  the  arch? 

A.  Sometimes.  When  the  lateral  is  tardy  in 
eruption  the  cuspid  comes  into  position  and  crowds 
the  lateral  into  the  vault. 

Q.  Is  the  cuspid  a  very  important  tooth? 

A.  It  is  the  most  important  tooth  in  the  anterior 
part  of  the  mouth  on  account  of  its  durability  and  in¬ 
fluence  on  expression.  Its  durability  is  due  to  its 
hardness  of  tissue,  its  slowness  of  development  and 
simplicity  of  shape. 

Q.  Is  it  liable  to  decay? 

A.  Because  of  shape  and  smoothness,  it  is  less 
liable  to  caries. 

Q,  Does  it  possess  great  strength? 

A.  Yes.  Owing  to  its  position,  length  of  root, 
together  with  its  order  of  evolution. 

Q.  Does  position  give  it  importance? 

A.  Being  placed  between  the  anterior  and  poste¬ 
rior  column,  it  forms  the  keystone  and  on  account  of 
its  prominence  gives  expression  to  the  face. 

Q.  To  what  may  be  due  deviation  from  the  nor¬ 
mal? 

A.  To  malposition  of  the  germ  or  crowding  out 
of  place. 

Q.  How  does  time  of  eruption  affect  this  tooth? 

A.  It  is  late  in  erupting,  therefore  it  must  crowd 
its  way  into  position. 

19 


236 


QUIZ  COMPEND 


Q.  Is  its  crypt  on  a  line  with  the  other  crypts? 

A.  It  is  outside  and  above  those  of  the  other  teeth. 

Q.  What  benefit  results? 

A.  It  being  above  and  on  a  larger  circle,  it  can 
crowd  in  between  the  other  teeth  and  crowd  them 
apart,  thereby  spreading  the  arch,  giving  it  a  para¬ 
bolic  outline  and  forming  a  keystone. 

Q.  What  effect  has  it  upon  the  jaw  when  it  re¬ 
mains  inside  or  outside  the  arch? 

A.  The  expanded  contour  is  lost  and  a  small 
pinched  condition  results,  usually  producing  a  V  or 
partial  V-shaped  arch. 

Q.  What  results  when  the  germs  are  misplaced  in 
the  arch? 

A.  The  cuspids  may  erupt  in  the  vault,  in  the 
floor  of  the  nose  or  they  may  remain  imbedded  cross¬ 
wise  in  the  bone. 

Q.  May  one  erupt  normally  and  the  other  irregu¬ 
larly? 

A.  That  is  not  uncommon. 

Q.  Is  bicuspid  shape  liable  to  interfere  with  nor¬ 
mal  development? 

A.  Yes.  The  antero-posterior  diameter  of'  its 
outer  cusp  is  greater  in  proportion  than  the  inner, 
producing  a  wedge  shape  space  on  the  palatal  side. 
This  causes  the  tooth  in  front  and  back  to  touch  at 
one  point. 

Q.  Which  bicuspid  is  most  liable  to  irregularities? 

A.  The  second. 

Q.  What  may  cause  irregularities  of  the  bicuspids? 

A.  Constitutional  causes;  lack  of  accord  between 

the  size  of  the  jaw  and  that  of  the  tooth  or  local 
causes. 


ON  IRREGULARITIES  pF  THE  TEETH.  „  237 

O.  What  are  local  causes? 

A.  Tardy  eruption,  deflection  due  to  the  retention 
of  the  temporary  teeth,  forward  movement  of  the 
molar  and  rotation  from  want  of  occlusion. 

Q.  Explain  why. 

A.  The  natural  order  is  first  bicuspid,  second 
bicuspid,  cuspid.  This  is  sometimes  so  changed  that 
the  first  bicuspid  is  followed  by  the  cuspid,  thus  push¬ 
ing  it  backward.  From  lack  of  space  the  second  bicus¬ 
pid  is  crowded  either  without  or  within  the  arch. 

Q.  What  effect  has  deflection? 

A.  When  a  temporary  molar  is  retained  too  long 
or  its  roots  are  not  absorbed  as  fast  as  the  bicuspid  is 
erupted,  it  is  deflected  or  caused  to  rotate  more  or  less 
upon  its  axis. 

Q.  What  effect  has  the  forward  movement  of  the 
molar  upon  the  bicuspids? 

A.  It  necessarily  diminishes  the  space  left,  for  the 
bicuspids  and  cuspids  and  when  the  first  bicuspid  and 
cuspid  erupt  before  the  second  bicuspid,  this  may  be 
crowded  out  of  its  proper  place. 

Q.  Does  rotation  produce  a  deformity? 

A.  A  rotation  of  the  bicuspid  from  want  of  proper 
occlusion  is  not  rare.  The  cusps  of  the  bicuspids  are 
designed  to  articulate  with  those  upon  the  opposite 
jaw.  When  its  two  cusps  fail  to  find  an  opposing  cusp 
to  keep  it  in  place  its  function  is  lost. 

Q.  Do  not  all  these  causes  often  work  together? 

A.  Frequently  more  than  one  of  these  causes  are 
at  work  or  one  implies  another. 

Q.  How  do  irregularities  of  the  teeth  attract 
attention? 

A.  They  attract  attention  by  their  deformity  and 


238 


QUIZ  COMPEND 


not  by  their  interference  with  function.  It  is  easy  to 
observe  displacement  of  individual  teeth  in  the  ante¬ 
rior  dental  arch. 

Q.  Does  the  removal  of  a  tooth  cause  irregulari¬ 
ties? 

A.  As  soon  as  a  tooth  is  removed  from  a  normal 
dental- arch  improper  occlusion  and  articulation  must 
result. 

Q.  Which  tooth  is  most  often  injudiciously  ex¬ 
tracted? 

A.  The  first  permanent  molar. 

Q.  Is  it  universally  removed  when  decayed? 

A.  Not  in  all  countries. 

Q.  Should  it  be  removed? 

A.  No. 

Q.  What  reasons  are  given  for  its  removal? 

A.  That  the  dental  arch  is  small  and  by  its  re¬ 
moval  it  will  give  room  for  the  other  teeth  to  come 
into  place.  When  removed  early  the  other  molars  will 
move  forward  and  fill  the  space. 

Q.  Is  this  good  reasoning? 

A.  It  is  not.  Malocclusion  more  or  less  will 
occur  in  every  case. 

Q.  What  has  been  the  cause  of  the  removal  of  the 
first  permanent  molar? 

A.  Its  early  decay  brought  about  by  the  tax  upon 
the  growing  child  and  neglect  for  which  the  teeth 
suffer  during  the  period  of  its  development.  The 
parent  usually  does  not  know  of  its  existence  until  the 
child  complains  of  toothache.  It  is  also  removed  to 
correct  an  overcrowded  arch. 

Q.  Does  its  extraction  relieve  the  crowded  arch? 

A.  It  does.  More  room  is  produced  than  is  re- 


ON  IRREGULARITIES  OF  THE  TEETH.  239 

quired.  As  a  result  the  remaining  teeth  are  out  of 
position  and  their  surfaces  do  not  articulate  properly 
with  those  upon  the  opposite  jaw.  . 

Q.  Has  wholesale  extraction  of  the  first  perma¬ 
nent  molar  had  a  beneficial  effect? 

A.  It  has  not.  It  is  hastening  arrest  of  develop¬ 
ment  of  the  jaws  and  alveolar  process  since  develop¬ 
ment  of  these  depends  largely  upon  the  function  of 
the  teeth  and  their  articulation  for  the  motion  stimu¬ 
lates  nutrition  and  enlarges  the  arch. 

Q.  What  shows  that  arrest  of  development  of  the 
jaws  takes  place  when  the  teeth  are  extracted? 

A.  In  every  case  when  the  germ  of  the  teeth  is  not 
present  or  when  a  tooth  becomes  imbedded  in  the 
jaw,  arrest  of  the  bones  takes  place. 

Q.  What  effect  does  the  loss  of  the  first  perma¬ 
nent  molar  have  upon  the  individual? 

A.  The  loss  of  the  first  permanent  molar  impedes 
mastication  and  produces  vicious  occlusion  and  is  det¬ 
rimental  to  the  contour  of  the  face. 

Q.  What  effect  does  malocclusion  have  upon  the 
general  health? 

A.  The  food  is  not  properly  masticated  and  the 
health  may  become  seriously  impaired. 

Q.  In  what  other  way  is  mastication  interfered 
with? 

A.  When  teeth  here  and  there  are  extracted,  the 
arch  is  broken  and  the  teeth  are  liable  to  move  for¬ 
ward  and  backward,  thus  causing  them  to  occlude 
between  each  other.  These  elongate  and  have  no 
occlusal  surfaces;  mastication  is  impossible. 

Q.  May  teeth  extracted  upon  one  side  interfere 
with  symmetry? 


240 


QUIZ  COMPEND 


A.  When  the  first  permanent  molar  is  prema¬ 
turely  extracted  upon  one  side,  the  position  of  that 
side  is  interfered  with.  The  length  of  the  rami, 
body,  depth  of  sulci  of  the  masticatory  surfaces  may 
be  affected  to  such  an  extent  that  bi-lateral  asym¬ 
metry  results. 

Q.  Should  the  first  permanent  molar  be  extracted 
when  decayed? 

A.  No.  It  would  be  better  to  fill  the  roots  and 
replace  the  tooth  with  a  gold  crown  until  all  the  teeth 
have  developed  and  articulate  properly. 

Q.  Should  there  not  be  room  for  the  third  molar 
to  come  into  place,  what  is  indicated? 

A.  All  the  other  teeth  will  have  erupted  and 
found  their  proper  positions  by  the  time  the  third 
molar  is  ready  to  erupt ;  if  there  be  not  room,  extract 
the  third  molar 


CHAPTER  XXVII. 


LOCAL  CAUSES  OF  TEETH  IRREGULARITIES— 

LOWER  JAW. 

Q.  Are  the  two  jaws  alike? 

A.  The  jaws  are  distinct  in  character,  function 
and  course  of  development.  The  upper  jaw  when 
normal  describes  a  larger  circle,  the  teeth  overlap¬ 
ping  the  lower.  It  is  fixed  and  depends  for  its  func¬ 
tion  on  the  activity  of  the  lower. 

Q.  Are  irregularities  as  common  upon  the  lower  as 
upon  the  upper? 

A.  Owing  to  the  immobility  of  the  upper,  irregu¬ 
larities  are  more  markedly  constitutional  than  on  the 
lower.  Thus  various  abnormal  dental  arches  are  not 
seen  in  the  lower  while  the  high  and  narrow  vault 
and  inward  curve  of  the  alveolar  process  occurs. 
The  lower  is  restrained  by  the  overlapping  of  the 
upper.  Motion  of  the  lower  jaw  prevents  deform¬ 
ities. 

Q.  Are  the  lower  teeth  more  liable  to  local  irregu¬ 
larities  than  the  upper? 

A.  Yes,  because  the  lower  arch  articulates  inside 
of  the  upper. 

Q.  How  are  the  anterior  inferior  teeth  arranged? 

A.  The  points  of  contact  are  at  the  cutting  edge. 
The  mesial  and  distal  edges  are  rounded,  which  enables 
them  to  crowd  easily  past  each  other  when  force  is 
applied. 

Q.  How  are  their  roots  arranged? 

241 


242 


QUIZ  COMPEND 


A.  The  roots  are  flattened  to  the  sides  so  that 
when  pressure  is  brought  to  bear  upon  them  they 
move  with  readiness  over  a  considerable  distance. 

Q.  Are  the  incisors  carried  forward  by  the  pos¬ 
terior  column? 

A.  They  are  not.  The  line  of  force  is  in  straight 
lines  alone. 

Q.  What  effect  does  the  force  produce? 

A.  The  force  is  direct  upon  the  cuspid;  meeting 
with  slight  resistance  at  the  side  by  the  incisor,  they 
are  carried  forward. 

Q.  Are  local  irregularities  common  back  of  the 
cuspids? 

A.  They  are  not. 

Q.  What  are  the  most  frequent  forms? 

A.  They  occur  in  connection  with  the  incisors. 

Q.  Why? 

A.  The  teeth  and  jaws  are  not  in  harmony.  The 
teeth  of  the  lower  jaw  are  forced  inward  by  occlusion 
and  the  forward  movement  of  the  posterior  column. 

Q.  Do  the  two  lateral  arches  produce  common 
deformities? 

A.  Like  those  upon  the  upper  jaw,  they  are  never 
alike. 

Q.  What  pressure  is  brought  to  bear  upon  the 
anterior  teeth? 

A.  When  the  second  and  third  molars  erupt  the 
pressure  is  directed  forward. 

Q.  What  effect  does  the  forward  movement  have 
upon  the  teeth? 

A.  Owing  to  the  incline  upon  the  lateral  surfaces 
of  the  incisors,  the  forward  movement  of  the  cuspid 
pushes  against  the  lateral  and  carries  it  inwards. 


ON  IRREGULARITIES  OF  THE  TEETH. 


243 


Q.  Do  these  teeth  always  stand  in  the  same  posi¬ 
tion? 

A.  They  do  not.  They  stand  at  different  angles 
depending  upon  the  local  peculiarities.  Thus  a 
cuspid  or  lateral  may  strike  outside  of  its  antagonist  of 
the  opposite  jaw 

Q.  When  both  posterior  columns  move  forward 
what  position  do  the  incisors  sometimes  take? 

A.  Both  lateral  incisors  are  carried  inward;  a 
V-shaped  arch  is  prevented  by  the  central  coming  in 
contact  with  the  superior  incisor. 

Q.  What  should  be  borne  in  mind  in  correcting 
such  a  deformity? 

A.  If  the  force  and  mode  of  application  be  borne  in 
mind,  it  will  be  understood  why  extremes  of  a  lower 
lateral  or  central  render  this  irregularity  worse  inas¬ 
much  as  they  disarrange  occlusion  of  the  cuspid. 

Q.  If  the  central  stands  just  a  little  inward  and 
force  is  applied  what  results? 

A.  The  cuspid  pushes  against  the  lateral  and  the 
central  is  carried  backward. 

O.  When  the  inferior  cuspid  develops  out  of  line 
where  is  it  located? 

A.  It  is  always  anterior  to  its  normal  position. 

Q.  Where  does  the  cuspid  usually  erupt  when  mal¬ 
position  of  the  germs  takes  place? 

A.  Either  outside  of  the  incisor  or  in  line  with  them. 

Q.  What  is  the  cause  when  the  bicuspids  are  either 
outside  or  inside  the  arch? 

A.  It  is  due  to  the  retention  of  the  temporary 
teeth. 

Q.  What  takes  place  when  the  second  temporary 
molars  are  retained  too  long? 


244 


QUIZ  COMPEND 


A„  The  first  permanent  molars  may  move  forward, 
thus  confining  the  cuspid  and  preventing  its  eruption. 

Q.  Do  teeth  move  about  in  the  alveolar  process? 

A.  Yes.  Where  there  is  no  occlusion  or  antago¬ 
nism,  they  will  move  up,  down  or  laterally  until  they 
rest  against  something,  it  may  be  tooth,  gum  or  arti¬ 
ficial  resistance. 

Q.  How  is  this  motion  best  corrected? 

A.  By  perfect  occlusion  and  proper  relation 
between  waste  and  repair. 

Q.  What  is  perfect  occlusion? 

A.  Each  tooth  is  kept  in  place  by  its  adjoining 
neighbor  and  the  opposing  tooth,  and  dislodgment  is 
impossible. 

Q.  Does  this  occlusion  differ  in  different  teeth? 

A.  Yes.  The  upper  and  lower  incisors  over¬ 
lap  each  other,  producing  what  is  termed  the  over¬ 
bite.  In  the  normal  relation  they  strike  in ‘straight 
lines  which  pass  through  the  roots.  .  The  teeth  are 
thus  held  in  position.  The  relation  of  cuspids  is 
similar. 

Q.  What  is  the  relation  of  the  bicuspid  and 
molars? 

A.  The  cusps  of  one  tooth  strike  direct  upon 
half  of  two  of  the  opposite  jaw.  When  one  of  these 
teeth  are  extracted,  the  order  of  the  mouth  is  distrib¬ 
uted  and  re-arrangement  of  the  teeth  takes  place. 
What  this  will  be,  depends  upon  a  variety  of  circum¬ 
stances. 

Q.  Give  an  example. 

A.  By  extraction  of  the  first  permanent  molar, 
forward  movement  of  the  second  molar  necessarily 
follows.  The  tooth  tilts  forward.  The  posterior  cusp 


ON  IRREGULARITIES  OF  THE  TEETH. 


245 


of  the  first  upper  molar  strikes  the  anterior  cusp  of 
the  second  lower  and  exerts  its  whole  force,  which 
was  meant  to  be  distributed  over  its  entire  surface. 

Q.  What  is  understood  by  perfect  relation  between 
waste  and  repair? 

A.  The  alveolar  process  is  a  transitory  structure; 
building  up  and  tearing  down  of  bone  cells  is  going 
on  very  rapidly.  This  is  illustrated  in  the  eruption  of 
the  deciduous  teeth  and  again  in  the  eruption  of  the 
permanent  and  after  the  teeth  are  extracted  the  pro¬ 
cess  is  again  absorbed  away.  Position  of  the  teeth 
in  the  alveolar  process  is  determined  by  the  tissue 
about  them. 

Q.  What  else  demonstrates  the  deposition  and 
absorption  of  bone  cells? 

A.  Pressure  on  a  tooth  in  a  given  direction  will 
remove  bone  cells  in  one  direction  and  deposit  them 
in  another. 

Q.  Does  every  tooth  exert  a  pressure  of  its  own? 

A.  Yes.  Did  it  not,  elongation  of  a  tooth  when  its 
opponent  is  extracted  could  not  be  accounted  for. 

Q.  What  follows  when  the  two  fundamental  laws  of 
good  occlusion  and  balanced  waste  and  repair  are  vio¬ 
lated? 

A.  Movement  of  individual  teeth  in  straight  lines. 
Rotation  of  individual  teeth  upon  their  axis  and  for¬ 
ward  movement  of  groups  of  teeth. 

Q.  What  sometimes  causes  the  space  between  the 
central  incisors? 

A.  It  is  due  to  a  continuous  growth  of  the  suture. 
This  usually  begins  at  ah  early  period  of  life  and  con¬ 
tinues  until  growth  of  the  osseous  system  has  ceased. 
Irritation  is  kept  up  by  mastication. 


246 


QUIZ  COMPEND 


Q.  May  not  irritation  sufficient;  to  produce  absorp¬ 
tion  be  of  artificial  creation? 

A.  Yes.  As  in  wedging  to  obtain  room  for  filling 
teeth.  Correcting  irregularities  of  the  teeth  will  set 
up  irritation,  sometimes  continuing  indefinitely  and 
causing  a  tooth  or  teeth  to  migrate. 

Q.  Do  the  teeth  of  one  jaw  sometimes  press  too 
hard  upon  those  of  the  other  causing  migration? 

X  O  O 

A.  The  teeth  of  the  lower  jaw  (especially  the  incis¬ 
ors)  pushing  against  the  upper  centrals  may  cause 
them  to  move  out  of  position. 

Q,  What  common  irregularity  is  due  to  deposit  of 
bone  cells? 

A.  That  in  which  the  inferior  incisors  impinge 
upon  the  mucous  membrane  of  the  vault. 

Q.  What  causes  this? 

A.  There  is  an  unbalanced  nervous  system.  There 
may  be  arrests  of  the  inferior  maxilla  or  excessive 
development  of  the  superior.  In  either  case  excess¬ 
ive  development  of  the  inferior  alveolar  process  re¬ 
sults,  developing  the  incisors  beyond  their  normal 
position. 

Q.  What  effect  does  this  have  upon  the  vault? 

A.  It  causes  irritation  of  the  mucous  membrane, 
causing  a  deposition  of  bone  cells.  These  carry  the 
superior  alveolar  process  and  teeth  forward,  causing 
the  teeth  to  protrude  between  the  lips.  This  deform¬ 
ity  is  common  in  neurotics  and  degenerates. 

Q.  Does  the  forward  movement  increase  the  spaces 
between  the  teeth? 

A.  It  does.  The  teeth  being  carried  to  a  large 
circle  the  spaces  between  the  teeth  naturally  en¬ 
large. 


ON  IRREGULARITIES  OF  THE  TEETH. 


247 


Q.  Does  lack  of  functionation  encourage  deposi¬ 
tion  of  lime  salts  around  tooth  roots? 

A.  Yes.  When  teeth  are  removed  from  one  jaw 
the  alveolar  process  about  the  teeth  on  the  opposite 
jaw  will  elongate  until  the  tooth  or  teeth  meet  resist¬ 
ance. 

Q.  Does  inflammation  build  up  as  well  as  tear  down 
bone  tissue? 

A.  Inflammation  due  to  local  as  well  as  constitu¬ 
tional  causes  may  build  up  or  absorption  of  tissue 
may  ensue. 

Q.  Is  inflammation  from  constitutional  causes  likely 
to  affect  the  alveolar  process? 

A.  Interstitial  gingivitis  therefore  may  set  in,  pro¬ 
ducing  absorption  of  the  alveolar  process  without  at 
first  affecting  the  gums. 

Q.  Does  infection  take  place? 

A.  Pus  infection  readily  results  with  deposit  of  the 
bone  absorption  upon  title  roots  of  the  teeth. 


% 


. 


. 


. 


CHAPTER  XXVIII. 


LOCAL  CAUSES  OF  TEETH  IRREGULARITIES— 

FINGER-SUCKING. 

Q.  To  what  has  the  high  vault  been  attributed? 

A.  To  thumb-sucking. 

Q.  Can  the  high  vault  and  V  and  saddle  shaped 
arches  be  ascribed  indiscriminately  to  thumb-sucking? 

A.  Yes. 

Q.  What  is  the  vault  shape  where  there  is  finger¬ 
sucking? 

A.  It  may  be  high  or  low. 

Q.  Are  the  teeth  and  alveolar  process  involved? 

A.  Yes.  The  teeth  are  sometimes  carried  out  fan¬ 
shaped  with  spaces  between  them. 

Q.  Which  teeth  are  involved? 

A.  Sometimes  upon  one  side  and  sometimes  upon 
the  other.  Sometimes  those  in  the  center  are  affected'. 
This  depends-  entirely  upon  which  finger  and  hand  and 
the  position  used. 

Q.  How  do  these  deformities  differ  from  the 
V-shaped  arch? 

A.  In  the  V-shaped  arch,  the  teeth  are  crowded 
and  pointed  toward  the*  center  owing  to  the  force 
applied  by  the  posterior  column  and  spent  hpon  both 
halves  toward  the  median  line.  The  vault  may  or 
may  not  be  arched. 

Q.  How  does  it  compare  with  the  saddle  arch? 

A.  In  saddle-shaped  arches  the  teeth  are  crowded 

249 


250 


QUIZ  COMPEND 


(except  in  cases  due  to  hypertrophy)  and  the  teeth  stand 
perpendicular.  The  vault  may  be  high  or  low. 

Q.  How  are  they  arranged  where  there  is  thumb¬ 
sucking? 

A.  The  teeth  of  the  inferior  maxilla  do  not  articu¬ 
late  with  the  upper  and  are  often  turned  inward 
which  is  caused  by  the  pressure  of  the  thumb  upon 
the  cutting  edge. 

Q.  Where  are  the  evidences  of  thumb-sucking? 

A.  The  spreading  of  all  or  a  part  of  the  anterior 
teeth  and  the  lower  teeth  are  usually  turned  inward. 
When  the  vault  is  high  the  deformity  may  be  quite 
marked  in  the  anterior  portion  of  the  vault.  This, 
however,  is  by  no  means  characteristic. 

Q.  Is  the  thumb-sucking  habit  prolonged  until  the 
second  teeth  erupt? 

A.  Not  as  a  rule.  It  usually  terminates  before 
their  eruption. 

Q.  How  early  do  infants  begin  to  suck  their 
fingers? 

A.  Within  a  few  hours  after  birth.  In  a  majority 
of  cases  not  later  than  the  first  week.  The  habit  is 
fixed  before  the  temporary  teeth  begin  to  erupt. 

Q.  Are  the  alveolar  process  and  first  teeth  only 
affected? 

A.  If  the  pressure  be  continuous  they  are. 

Q.  To  what  extent? 

A.  The  shape  and  location  of  the  irregularity 
depends  upon  the  hand  employed  and  the  position  of 
the  thumb  and  finger  used.  The  right  or  left  side  is 
affected  according  to  the  hand  used,  though  occasion¬ 
ally  it  is  found  at  the  median  line. 

Q.  Are  the  permanent  teeth  often  involved? 


ON  IRREGULARITIES  OF  THE  TEETH. 


251 


A.  As  the  child  usually  discontinues  the  habit 
before  the  time  of  eruption  of  the  permanent  teeth, 
deformities  produced  by  thumb-sucking  are  usually 
confined  to  the  temporary  set. 

Q.  Is  the  superior  alveolar  process  involved? 

A.  If  the  child  continue  to  suck  its  thumb  or  finger 
while  the  second  set  are  erupting,  arrest  of  the  alveolar 
process  will  take  place  and  the  teeth  will  be  separated. 

Q.  What  position  do  the  teeth  take? 

A.  They  take  the  position  of  the  thing  sucked. 

Q.  Is  the  vault  carried  up  by  thumb-sucking? 

A.  No.  The  high  vault  is  not  formed  until  all  the 
second  teeth  are  in  position.  It  is  impossible  for  the 
child  to  carry  the  thumb  or  finger  the  entire  length 
of  the  vault. 


CHAPTER  XXIX. 


THE  DEGENERATE  TEETH. 

Q.  What  were  the  teeth  originally? 

A.  They  were  primitive  organs  of  the  skin  which 
developed  over  the  surface  of  the  body. 

Q.  What  change  took  place? 

A.  They  became  dermal  bones  like  those  which 
went  to  form  part  of  the  skull.  The  placoid  scales 
which  were  dermal  teeth  in  the  shark  helped  out 
deficiency  of  the  brain  case. 

Q.  Why  did  the  placoid  scales  or  dermal  teeth  un¬ 
dergo  this  change? 

A.  Because  in  vertebrate  evolution  the  cartilagin¬ 
ous  brain  case  was  hardly  sufficient  to  cover  the  devel¬ 
oping  brain. 

Q.  How  did  the  teeth  of  sharks  change  the  prim¬ 
itive  method  of  development? 

A.  Instead  of  developing  upon  the  surface,  the 
dermoid  tissue  dipped  down  deep  into  the  structure 
below. 

Q.  Is  this  a  degeneration? 

A.  The  method  of  tooth  formation  converting 
epithelial  cells  without  vascular  supply  into  enamel 
was  a  degeneration  in  itself. 

Q.  What  takes  place  down  in  the  deeper  tissues? 

A.  A  papilla  forms  in  the  dermis  which  eventually 
becomes  the  dentine  of  the  tooth. 

Q.  After  the  epidermis  dips  into  the  tissue  below, 

253 


254 


QUIZ  COMPEND 


enlarges  and  adds  the  enamel,  what  becomes  of  the 
debris? 

A.  The  debris  resulting  therefrom  as  observed  in 
animals  and  man  forms  degenerations  or  “abortive 
rudiments”  of  tooth  succession  as  observed  in  sharks, 
some  whales  and  reptiles. 

Q.  Where  does  the  tooth  obtain  its  shape  and 
size? 

A.  From  the  pulp  which  develops  deep  down  in 
the  tissue. 

Q.  Where  does  calcification  first  take  place? 

A.  It  first  takes  place  upon  the  periphery  while  the 
blood  vessels  and  connective  tissue  recede  until  finally 
the  root  is  completely  formed ;  only  a  minute  opening  is 
left  for  the  passage  of  an  artery,  nerve  and  vein. 

Q.  For  what  purpose  are  these  structures? 

A.  For  nourishment  of  the  pulp  as  well  as  tooth 
structure. 

Q.  What  is  tooth  formation  as  compared  with  that 
of  the  placoid  scales? 

A.  The  method  of  formation  of  the  tooth  itself  is 
a  degeneration  and  intended  for  temporary  use  alone. 

Q.  What  effect  do  morbid  states  have  upon  the 
teeth? 

A.  Diseases  and  traumatism  which  affect  the 
human  body  as  well  as  the  embryo  must  necessarily 
affect  structures  so  poorly  nourished  as  the  teeth  and 
their  germs. 

Q.  What  takes  place  in  the  evolution  of  the  alve¬ 
olar  process? 

A.  Change  in  the  shape  of  the  alveolar  process, 
neglect  of  hygiene  causes  interstitial  gingivitis  and 
endarteritis  obliterans  (thus  preventing  circulation 


ON  IRREGULARITIES  OF  THE  TEETH. 


255 


and  nourishment  of  the  teeth)  and  removes  resistance, 
thus  furnishing  a  suitable  medium  for  micro-organ¬ 
isms. 

Q.  What  are  some  marked  degenerations  of  the 
enamel? 

A.  Interglobular  spaces  and  enamel  defective  in 
quality  and  quantity. 

Q.  Is  tooth  decay  degeneration? 

A.  Tooth  decay  is  a  marked  degeneration,  but 
sometimes  a  normal  process  (normal  senility)  for  the 
carrying  out  of  which  osteomalaciary  methods  are 
provided. 

Q.  In  what  animals  are  the  teeth  continuous? 

A.  In  polyphyodont  (continuous  tooth)  animals, 
the  teeth  come  and  go.  Periods  of  stress  are  not  in¬ 
volved  in  individual  teeth. 

Q.  How  is  it  in  man? 

A.  Tooth  degeneration  is  normally  a  continuous 
one,  and  since  man  has  only  two  sets,  they  undergo 
degeneration  through  the  periods  of  stress. 

Q.  How  many  teeth  has  man? 

A.  At  his  present  stage  of  evolution  he  has  twenty 
in  the  temporary  and  thirty-two  in  the  permanent  set. 

Q.  If  there  is  any  deviation  in  these  numbers  at 
what  period  must  it  take  place? 

A.  Any  change  in  number  is  the  result  of  embry¬ 
onic  change  occurring  between  the  sixth  and  fifteenth 
week  for  the  temporary  set  and  the  fifteenth  week 
and  birth  for  the  permanent  set. 

Q.  When  teeth  erupt  late  in  life  what  are  they 
called? 

A.  They  are  called  third  sets. 

Q.  Are  they  third  sets? 


256 


QUIZ  COMPEND 


A.  Properly  not,  because  the  germs  must  devel¬ 
op  with  those  of  the  other  sets. 

Q.  Why  are  they  so  tardy  in  eruption? 

A.  For  want  of  dynamic  force  to  propel  them 
into  place. 

Q.  Are  they  ever  obstructed  or  mal-imposed? 

A.  They  are  frequently  misplaced  in  the  jaw,  and 
again  they  are  frequently  held  in  the  jaw  by  the  other 
set. 

Q.  What  does  it  denote  when  there  are  more  than 
twenty  in  the  temporary  or  thirty-two  in  the  perma¬ 
nent  set? 

A.  Atavism. 

Q.  When  did  man  reach  his  highest  physical 
development? 

A.  When  well  developed  jaws  held  twenty  tempo¬ 
rary  and  thirty-two  permanent  teeth. 

Q.  When  there  is  a  decrease  in  number  what  does 
it  mean? 

A.  Decrease  in  number  from  the  dental  stand¬ 
point  means  degeneracy  of  the  jaws  and  teeth. 

Q.  What  does  such  jaw  and  tooth  degeneracy 
mean? 

A.  It  means  a  marked  advance  in  the  man’s  evo¬ 
lution  as  a  complete  being. 

Q.  What  was  the  dental  formula  of  most  general¬ 
ized  primate? 

A.  In  the  New  Mexican  lower’eocene  occur  a  few 
representatives  of  the  lowest  primate,  such  as  the 
lemurarius  and  limnotherum,  each  the  type  of  a  dis¬ 
tinct  family.  The  lemurarius  most  nearly  allied  to 
the  lemurs  is  the  most  generalized  primate  yet  found. 


ON  IRREGULARITIES  OF  THE  TEETH.  257 

It  had  forty-four  teeth  in  continuous  series  above 
and  below. 

Q.  What  do  supernumerary  teeth  indicate? 

A.  An  atavism  which  demonstrates  that  man  dur¬ 
ing  his  evolution  from  the  lowest  primates  has  lost 
twelve  teeth. 

Q.  How  many  forms  do  supernumerary  teeth 
assume? 

A.  Two.  They  either  resemble  adjoining  teeth 
or  are  cone-shaped.  They  rarely  are  exactly  counter¬ 
parts.  Each  tooth  may  be  duplicated. 

Q.  What  shape  do  teeth  that  fail  to  approximate 
normal  neighbors  assume? 

A.  They  always  assume  the  cone-shape  of  the 
primitive  tooth. 

Q.  Where  are  supernumerary  teeth  usually  located 
in  the  mouth,  and  what  significance  has  this? 

A.  In  a  majority  of  cases  either  in  the  extreme 
anterior  or  posterior  part  of  the  mouth.  This  dem¬ 
onstrates  that  the  teeth  resemble  in  number  those  of 
the  primates  and  that  they  have  been  dropped  off  at 
either  end  of  the  jaw. 

Q.  Do  they  occur  elsewhere? 

A.  Yes,  but  when  present  they  are  not  usually 
cone-shaped  but  take  normal  shapes. 

Q.  What  is  indicated  by  the  fact  that  the  cone- 
shaped  tooth  as  a  rule  is  perfect  in  construction? 

A.  It  is  of  much  value  in  outlining  tooth  and  jaw 
evolution,  especially  from  degeneracy  aspects. 

Q.  What  is  taking  place  in  the  evolution  of  the 
jaw? 

A.  It  is  shortening  in  both  directions. 

Q.  How  long  will  this  shortening  continue? 


258 


QUIZ  COMPEND 


A.  So  long  as  the  jaw  must  be  adjusted  to  a  vary¬ 
ing  environment. 

Q.  What  shows  that  the  jaw  is  undergoing  trans¬ 
ition? 

A.  .  The  jaw  of  man  originally  contained  more 
teeth  than  at  present.  Lack  of  adjustment  to  environ¬ 
ment  produces  from  the  shortening,  degeneracy  of  the 
jaws  and  atavism  of  the  teeth. 

Q.  What  does  this  indicate? 

A.  While  degeneracy  of  the  jaws  indicates  general 
advance  it  also  demonstrates  that  man  is  not  yet 
adjusted  to  his  new  environment. 

Q.  What  does  shortening  of  the  jaw  cause? 

A.  It  causes  supernumerary  cone-shaped  teeth  to 
erupt  in  mass  at  the  extreme  ends  of  the  jaw. 

Q.  Are  cone-shaped  teeth  often  seen  on  the  lower 
jaw? 

A.  No.  Mobility  of  the  lower  jaw  prevents  mal¬ 
adjustment  to  environment  present  in  the  upper. 

Q.  What  effect  has  shortening  upon  the  third 
molars? 

A.  It  causes  them  to  be  so  wedged  in  between  the 

angle  of  the  jaw  and  the  second  molar  that  eruption  is 

\ 

impossible.  It  may  tip  forward  and  strike  the  second 
molar  in  an  abnormal  position  or  it  may  be  missing 
altogether. 

Q.  What  per  cent,  are  missing? 

A.  In  670  patients  forty-six  per  cent. 

Q.  From  the  shortening  of  the  mal-adjustment  and 
disappearance,  what  inference  results  as' to  this  tooth? 

A.  This  tooth  seems  destined  to  disappear. 

Q.  Is  it  more  often  absent  upon  the  upper  than 
the  lower? 


ON  IRREGULARITIES  OF  THE  TEETH. 


259 


A.  Yes. 

Q.  When  it  is  absent,  what  general  conditions 
exist? 

A.  The  jaw  is  small  and  teeth  irregularities  are 
frequent,  nasal  stenosis,  nasal  bone  and  mucous  mem¬ 
brane  hypertrophy,  adenoids  and  eye  disorders  co-exist. 

Q.  After  the  third  molar  which  tooth  is  next  des¬ 
tined  to  disappear? 

A.  The  lateral  incisor. 

Q.  What  per  cent,  are  lost? 

A.  Of  670  persons,  fourteen'per  cent,  were  miss¬ 
ing 

Q.  How  many  laterals  have  the  lower  mammals? 

A.  Two  laterals,  and  the  other  is  destined  to  dis¬ 
appear. 

0.  Are  other  teeth  sometimes  missing? 

A.  In  degenerates,  it  is  not  uncommon  to  find 
centrals,  cuspids,  biscuspids  and  even  molars  miss¬ 
ing.  In  markedly  degenerate  jaws,  second  as  well  as 
third  molars  are  frequently  absent. 

Q.  What  do  missing  teeth  indicate? 

A.  Lack  of  development  of  germs,  due  to  either 
heredity  or  defective  maternal  nutrition  at  the  time  of 
conception  or  during  early  pregnancy. 

Q.  What  teeth  tend  to  conation? 

A.  Crescent-shape  bitubercular,  tritubercular  as 
well  as  deformed  teeth  tend  to  the  cone-shape. 

Q.  Why  do  these  malformations  take  place? 

A.  They  result  from  pre-congenital  trophic 
changes  in  dentine  development. 

O.  In  what  does  it  consist? 

A.  In  dwarfing  and  notching  the  "cutting  and 
grinding  edges  of  the  second  set  of  teeth. 


260 


QUIZ  COMPEND 


Q.  What  is  one  of  the  marked  deformities  of  the 
teeth? 

A.  Hutchinson’s  teeth.  Because  Hutchinson  first 
described  them  in  connection  with  syphilis. 

Q.  "What  are  Hutchinson’s  teeth? 

A.  They  consist  of  incisors  drawn  together  (cone- 
shape)  at  the  edges  and  hollowed  out  at  the  center. 

Q.  Are  these  teeth  pathognomonic  of  syphilis? 

A.  They  are  not  without  other  diagnostic  signs. 
They  alone  would  not  decide  a  case  of  lues. 

Q.  Did  Hutchinson  claim  that  these  teeth  were 
pathognomonic? 

A.  No.  He  admits  that  in  at  least  one-tenth  the 
cases  luetic  etiology  could  be  excluded.  Lues  only 
plays  the  part  of  a  diathetic  state  profoundly  affecting 
the  material  constitution  at  the  time  of  dentine  and 
enamel  development. 

Q.  Are  these  marked  deformities  of  the  teeth  due 
to  other  causes  than  lues? 

A.  Yes.  Any  marked  constitutional  disturbance 
such  as  scarlet  fever,  typhoid  fever,  pneumonia,  etc., 
will  produce  like  results. 

Q.  What  do  these  teeth  resemble  from  an  atavistic 
standpoint? 

A.  The  coincidence  in  form  between  Hutchinson’s 
and  malformed  teeth  and  those  of  the  chameleon, 
demonstrate  that  tropho-neurotic  changes  produce 
atavistic  teeth. 

Q.  Do  all  teeth  sometimes  conate? 

A.  In  marked  forms  of  degeneracy,  the  teeth  upon 
both  upper  and  lower  jaws  will  sometimes  conate. 

Q.  In  the  evolution  of  the  teeth,  what  theories 
have  been  advanced? 


ON  IRREGULARITIES  OF  THE  TEETH.  261 

A.  Two.  The  differentiation  and  concrescence 
theories. 

Q.  Who  advanced  these  theories? 

A.  The  first  was  advanced  by  Osborn  and  Cope 
in  America;  the  second  by  Magitot  in  1877,  and  later 
b}^  Schwalbe,  Carl  Rosa,  and  Kurkenthal. 

Q.  What  is  the  differentiation  theory? 

A.  In  the  triassic  period,  the  first  mammals  pos¬ 
sessed  conical,  round,  reptilian  or  dolphin-like  teeth. 
Some  aberrant  types  had  complex  multi  tubercular 
teeth.  Descending  the  scale,  cusps  were  added  here 
and  there  forming  a  triangle.  In  the  primitive  carni¬ 
vore  miacis ,  a  heel  is  found  which  from  the  grinding 
surface  seems  to  have  spread  out  broad  as  the  trian¬ 
gle.  The  three  molars  in  this  animal  show  that  the 
anterior  triangular  portion  of  the  crown  has  been- 
simply  leveled  down  to  the  posterior  portion  of  the 
crown.  In  this  way  the  human  molar  tooth  with  its 
low  quadritubular  crowns  has  evolved  by  addition  of 
cusps  and  by  a  gradual  modeling  from  a  high 
crowned,  simple,  pointed  tooth.  By  this  budding  all 
the  teeth  are  developed. 

0.  What  is  the  concrescence  theory? 

A.  Cone  teeth  placed  as  they  lie  in  the  jaw 
of  the  whale,  would  represent  primitive  denti¬ 
tion.  In  the  course  of  time  a  number  of  these  teeth 
become  so  clustered  together  as  to  form  two  cusps  of 
a  bicuspid  and  four  cusps  of  a  human  molar.  Each 
one  of  the  whale  tooth  points  takes  the  place  of  one  of 
the  cusps  of  the  mammalian  tooth.  In  other  words  by 
concrescence,  four  teeth  are  so  brought  into  one  as 

to  constitute  the  four  cusps  of  the  molar  crown. 

21 


262 


QUIZ  CQMPEND 


Q.  From  the  degeneracy  standpoint  which  of 
these  theories  seems  to  be  correct? 

A.  In  degenerate  jaws  both  the  differentiation 

and  concrescence  theory  are  beautifully  illustrated. 

From  an  atavistic  standpoint  every  tooth  in  the  jaw  at 

one  point  or  another  may  display  rudimentary  cusps 

Teeth  are  found  joined  together  quite  frequently, 

especially  in  the  anterior  and  posterior  part  of  the 

mouth.  Thompson  remarks  that  there  is  a  graduation 

from  central  incisors  towards  the  bicuspids  in  evolu¬ 
tion. 

Q.  Is  this  graduation  observed  from  cuspid  to 
bicuspid  in  man? 

A.  The  general  opinion  is  that  it  is  not.  There 
are  indications,  however,  of  an  inner  cusp  or  cingu¬ 
lum  that  often  presents  itself  in  bicuspid  form  in  the 
lower  mammals,  like  the  mole  and  that  the  first  pre¬ 
molar  or  bicuspid  is  then  more  caniniform. 

Q.  Is  the  rudimentary  cingulum  or  inner  cusp 
seen  in  man? 

A;  They  are,  although  variable  and  erratic  as  to 
position.  The  condition  appears  in  degenerates  as  far 
ront  as  the  centrals  and  is  often  present  on  the  lin¬ 
gual  face  of  laterals  and  cuspids  of  man. 

Q.  Is  not  the  lingual  cusp  of  the  inferior  bicuspids 
often  fully  developed? 

A.  Yes. 

Q.  Is  it  quite  deficient  in  some  lower  apes  and 
semi-apes? 

A.  \  es.  Especially  in  the  lemurs. 

Q.  When  does  it  attain  its  highest  development? 

A.  In  the  anthropoids  and  in  man. 

Q.  Are  the  changes  noted  by  Osborn  in  the  level- 


ON  IRREGULARITIES  OF  THE  TEETH.  263 

ing  of  the  cusps  to  form  the  molar  ever  observed  in 
man? 

A.  Yes.  In  marked  degenerates. 

Q.  Do  indications  of  the  concrescence  theor)r 
occur  in  the  tooth  types  of  man? 

A.  Yes.  It  is  not  uncommon  to  find  incisors  and. 
cuspids  with  two  roots,  bicuspids  with  two  or  three 
roots  and  molars,  especially  the  third,  with  three,  four, 
five  and  six  showing  an  atavistic  tendency. 

Q.  Are  there  other  evidences  of  atavism  in  the 
molar  teeth? 

A.  Yes.  Dr.  S.  H.  Guilford  first  called  attention 
to  “compressed  or  flattened  crowns,”  as  later  did  Dr. 
W.  B.  Pearsoll  of  Dublin,  Ireland. 

O.  Are  they  frequently  seen? 

A.  They  are  very  common  in  arrested  and  degen¬ 
erate  jaws. 

Q.  Which  teeth  are  involved? 

A.  Always  the  last  one.  If  the  third  molar  is  in 
place,  it  is  the  tooth,  if  it  is  missing  then  the  second 
molar. 

O.  What  position  do  they  take? 

A.  The  crowns  and  roots  seem  to  retain  the  orig¬ 
inal  “triconodont”  type  with  cusps  and  roots  in  line. 

Q.  Are  the  roots  close  together  or  separated? 

A.  The  roots  are  sometimes  separated  containing 
two  or  three,  or  these  may  be  flattened  upon  the  sides 
with  a  number  of  markedly  deformed  pulp  canals. 

O.  What  other  anomalies  are  observed  in  degen- 
erate  jaws? 

.  A.  Through  the  operation  of  the  law  of  economy 
of  growth,  producing  arrest  and  excessive  development, 
edentulousness  and  excessive  dentition  occur. 


264 


OUiZ  COMPEND 


Q.  What  did  Darwin  find  as  to  hair  and  teeth? 

A.  That  hairless  dogs  have  imperfect  teeth. 
Here  the  dermic  defects  affected  the  animal  as  a 
whole,  other  organs  profiting  by  the  deficiency  of  hair 
and  teeth. 

Q.  What  did  Magitot  determine? 

A.  That  in  most  cases  of  hairy  men,  there  is  de¬ 
fective  or  irregular  dentition. 

Q.  What  did  Thurman  report? 

A.  The  case  of  a  man  fifty-eight  years  of  age  who 
was  almost  devoid  of  hair.  All  his  life  he  possessed 
only  four  teeth.  His  skin  was  delicate.  There  was 
absence  of  sensible  perspiration  and  tears. 

Q.  What  did  Williams  report? 

A.  The  case  of  a  fifteen-year-old  girl  who  had 
scarcely  any  eyebrows  or  hair  on  head  and  who  was 
destitute  of  eyelashes.  She  was  edentulous  and  had 
never  sensibly  perspired. 

Q.  Are  there  cases  on  record  with  few  or  no  teeth? 

A.  Yes.  Fox  reports  a  woman  who  had  but 
four  teeth  in  both  jaws.  Tomes  cites  several  similar 
instances.  Hutchinson  reports  a  child  who  was  per¬ 
fectly  edentulous  as  to  temporary  teeth,  but  whose 
permanent  teeth  duly  and  fully  erupted.  Guilford 
describes  a  man  of  forty-eight  years  congenitally  and 
permanently  edentulous  who  had  no  sense  of  smell 
and  almost  without  taste.  The  surface  of  the  body 
was  covered  with  fine  hair.  He  had  never  visibly  per¬ 
spired.  Otto  observed  two  brothers  who  were  eden¬ 
tulous. 

Q.  How  does  excessive  dentition  show  itself? 

A.  In  many  varieties.  Those  which  constitute  a 
return  to  the  polyphyodontia  of  the  lower  vertebrates. 


ON  IRREGULARITIES  OF  THE  TEETH. 


265 


Q.  State  some  of  these. 

A.  O.  Hildebrand  of  Gottingen,  Germany,  in  1889 
rep.orted  a  case  of  a  child  of  twelve  which  after  various 
operations  had  been  relieved  of  about  two  hundred 
teeth  of  various  sizes.  Two  years  later  (July,  1891) 
at  the  Surgical  Clinic,  it  was  found  that  both  sides  of 
the  lower  jaw  were  much  thickened  and  also  the  right 
upper.  There  were  found  seventeen  teeth,  part  of 
them  normally  developed,  others  in  an  undeveloped 
condition.  The  position  was  irregular.  From  the 
upper  and  lower  jaw  there  were  again  some  masses  of 
teeth  removed  which  represented  about  one  hundred 
and  fifteen.  There  were  also  found  two  glassy  bodies 
^about  the  size  of  two  peas  which  under  the  microscope 
showed  tooth  structure. 

Q.  What  does  this  indicate? 

A.  Return  to  the  polypliyodontia  from  arrest  of 
development  very  early  in  foetal  life. 

Q.  Are  there  other  illustrations  of  polyphyodontia? 

A.  Yes.  In  the  Paris  Dental  School  Museum  are 
several  milk  teeth  both  of  the  superior  and  inferior 
maxilla  fused  together.  Black  cites  a  case  where 
there  were  two  rows  of  teeth  in  the  superior  maxilla. 
Hellwig  has  observed  three  rows  of  teeth.  The 
ephemerides  contain  an  account  of  a  similar  anomaly. 

Q.  Are  teeth  found  about  the  head  elsewhere 
than  in  the  mouth? 

A.  Yes.  Gould  points  out  that  teeth  have  been 
found  in  the  nose,  orbit,  palate,  and  exceptionally,  as 
in  a  case  reported  by  Carver,  they  may  grow  from  the 
lower  eyelids.  Arrest  of  development  proceeding 
from  checked  development  at  the  senile  period  of 
foetal  life  may  evince  itself  in  senility  of  the  alveolar 


266 


QUIZ  COMPEND 


process,  as  in  the  case  reported  by  Bronzet  where  a 
child  of  twelve  had  but  half  its  teeth,  the  alveolar 
process  having  receded  as  in  old  age. 

Q.  Do  not  arrests  of  development  produce  poly- 
phyodont  conditions  in  man? 

A.  Yes.  Catching  reports  the  case  of  a  girl  who 
had  all  her  teeth  at  six  months  and  shed  them  at  nine. 
At  fifteen  months  she  had  a  full  set  once  more.  In 
six  weeks  thereafter  these  were  shed.  At  thirty 
months  she  had  a  full  set  again,  which  remained  until 
her  fourth  year,  when  came  another  set.  These 
remained  until  another  set  began  to  erupt  at  eleven 
and  became  the  permanent  set  at  fifteen. 

Q.  Is  there  a  relationship  between  dental  and 
dermal  tissues? 

A.  Dr.  A.  H.  Thompson  points  out  that  these 
structures  are  governed  by  the  same  laws,  subject  to 
the  same  influences  and  possess  the  same  phenomena 
of  character  as  allied  tissues.  The  relationship  and 
homology  of  the  teeth  with  the  derm  and  its  varied 
appendicular  productions  are  established  by  demon¬ 
stration.  Teeth,  spines,  scales,  dermal  plates,  feathers, 
hair,  nails,  bristles,  horn,  hoof,  etc. ,  varying  in  form 
and  apparent  purpose  as  much  as  tissue  can  well 
attain,  are  very  closely  related  in  structure  and  func¬ 
tion. 

Q.  Of  what  does  the  enamel  consist? 

A.  It  consists  of  decalcified  epithelium  cells  elab¬ 
orated  from  the  endurance  of  an  appointed  work  and 
service  in  the  economy. 

Q.  What  else  does  it  possess? 

A.  Enamel  like  the  epithelium  and  all  corneous 
structures  yields  keratin. 


ON  IRREGULARITIES  OF  THE  TEETH 


267 


Q.  What  would  result  from  this  under  certain  con¬ 
ditions? 

A.  In  such  unstable  structures  in  evolution  as  the 
teeth,  arrest  of  development  would  produce  for  this 
reason  horny  structures  in  place  of  enamel.  This 
occurs  physiologically.  In  the  oviparous  mammal  the 
duck-bill,  true  teeth  appear  in  the  embryonic  state  to 
give  way  later  by  what  Thompson  calls  suppressive 
economy  or  the  degenerative  results  of  the  struggle 
for  existence  between  the  organ  to  horny  structure. 
Irregular  enamel  is  found  normally  in  wombats. 

Q.  What  other  instances  may  be  cited? 

A.  Those  of  the  toothed  birds  of  the  tertiary. 

Q.  Do  these  conditions  exist  in  man? 

A.  In  neurotics  and  degenerates,  arrest  of  devel¬ 
opment  occurs,  hence  very  little  or  no  enamel  upon 
the  teeth. 


> 


I 


i 


CHAPTER  XXX. 


SURGICAL  DIAGNOSIS. 

Q.  What  is  necessary  to  a  successful  result  in 
treatment? 

A.  Knowledge  of  the  origin  of  disease  as  well 
as  of  the  symptoms. 

Q.  What  happens  when  the  symptoms  are  removed 
without  ascertaining  the  cause? 

A.  Treatment  fails  utterly  in  the  main  object,  the 
removal  or  amelioration  of  the  disorder. 

Q.  Should  the  dentist  go  outside  the  mouth  if 
necessary  to  find  the  origin  of  the  disorder? 

A.  The  dentist  should  be  trained  to  seek  the  cause 
wherever  it  may  be. 

Q.  Will  general  examination  of  the  face  and  jaws 
show  the  character  of  the  deformity? 

A.  The  contour  of  the  face,  the  facial  angle  and 
general  appearance  will  often  decide  the  extent  and 
character;  whether  there  be  a  V  or  saddle  arch,  ex¬ 
cessively  developed  alveolar  process  or  an  underhung 
jaw. 

Q.  What  is  the  first  principle  a  dentist  should 
adopt? 

A.  He  should  learn  what  constitutes  a  normal 
face  in  a  given  individual  or  nationality. 

Q.  Do  nationalities  differ  as  to  shape  and  contour 
of  the  face? 

A.  Most  decidedly.  The  dentist  should  see  the 

269 


270 


QUIZ  COMPEND 


jaw  has  a  normal  outline  or  belongs  to  the  V  or  saddle- 
shaped  variety. 

Q.  What  other  structures  are  involved? 

A.  The  vault  and  alveolar  process  and  the  occlusion 
(let  the  patient  open  and  close  the  mouth  slowly). 
The  beginner  should  familiarize  himself  with  tooth 
individuality  as  to  class,  outline  and  occlusion. 

Q.  What  takes  place  with  asymmetry  of  the  upper 
and  lower  jaws? 

A.  Occlusion  from  the  cuspid  back  is  usually 
wrong.  In  such  cases  the  upper  cuspid  generally 
strikes  in  front  of  the  lower  cuspid  instead  of  between 
it  and  the  bicuspid  disarranging  the  articulation  of 
every  tooth. 

Q.  Is  the  difficulty  in  local  irregularities  easily 
detected? 

A.  Yes.  It  is  either  found  in  the  alveolar  arch  or 
the  malposition  of  the  individual  tooth. 

Q.  What  would  be  the  first  inquiry? 

A.  The  family  history.  It  has  been  claimed  that 
it  is  useless  to  try  to  correct  an  irregularity  due  to 
family  type.  That  the  type  returns  despite  long 
continued  efforts.  This  is  an  error.  Especially  in 
this  country  from  change  in  climate  and  intermar¬ 
riage  do  shapes  of  heads,  faces,  and  jaws  pass  from 
one  extreme  to  the  other  in  four  generations.  Evolu¬ 
tion  in  face  and  jaw  goes  on  so  rapidly  that  the  tissues 
are  too  unstable  to  present  fixed  forms. 

Q.  Is  there  a  family  type? 

A.  No,  while  the  child  may  inherit  a  family  tj^pe 
of  face  still  irregularities  cannot  be  said  to  be  inherited 
since  the  order  and  manner  of  their  eruption  and 


ON  IRREGULARITIES  OF  THE  TEETH. 


271 


position  are  purely  mechanical  and  the  influence  of 
environment  comes  into  play. 

Q.  Can  the  character  of  the  jaw  and  irregularities 
of  the  teeth  always  be  settled? 

A.  No.  It  is  often  well  to  wait  until  the  patient  is 
of  an  age  when  the  permanent  type  can  be  determined. 

Q.  Why? 

A.  Correction,  of  tooth  irregularities  before  that 
period  often  gives  unsatisfactory  results. 

Q.  Can  all  cases  be  benefited? 

A.  If  taken  in  time  all  cases  may  be  made  less 
unsightly. 

Q.  What  will  assist  such  operations? 

A.  Knowledge  of  evolution  and  of  its  reverse  phase, 
degeneration,  as  well  as  of  heredity  and  atavism, 
are  necessary  factors  in  the  skill  of  the  operator. 

Q.  Before  operating,  what  should  be  done? 

A.  A  study  of  the  models  should  be  made.  In  prog¬ 
nosis,  extent  of  deformity  must  be  taken  into  consid¬ 
eration. 

Q.  Will  not  many  cases  correct  themselves? 

A.  Cuspids  and  bicuspids  not  infrequently  erupt 
out  of  position  but  gradually  find  their  proper  places. 
Deformities  during  second  dentition  are  common, 
while  some  deciduous  teeth  remain  in  the  mouth. 
These  often  right  themselves. 

Q.  Should  the  operator  state  absolutely  to  the 
patient  or  parent  the  ease  or  difficulty  of  correction  or 
time  required? 

A.  No.  Many  cases  which  seemingly  present  no 
difficulty  often  give  much  trouble  since  the  resistance 
cannot  be  determined. 

Q.  Should  a  case  be  hurried? 


272 


QUIZ  COMPEND 


A.  It  should  not.  Time  spent  in  careful  examina¬ 
tion  of  the  case  is  well  spent.  Haste  here,  as  else¬ 
where,  makes  waste. 

O.  What  must  be  studied? 

A.  Every  particular.  The  operator  must  forecast 
in  his  mind  appliances  to  be  used,  the  different  steps 
to  be  taken  and  time  required  before  prognosis  can  be 
given  with  approximate  .exactness. 

Q.  What  is  the  best  time  to  regulate  teeth? 

A.  This  will  depend  upon  the  nature  of  the  irreg¬ 
ularity.  Approximately  from  the  twelfth  to  the 
fourteenth  year. 

Q.  Is  not  this  a  very  critical  period  in  the  life  of 
the  individual? 

A.  It  is.  It  is  one  of  the  periods  of  stress  and  the 
period  most  impressible  in  the  growth  of  the  individ¬ 
ual.  The  transitional  period  between  childhood  and 
puberty. 

Q.  Why  then  select  this  time? 

A.  Because  all  the  teeth  are  erupted,  general  nutri¬ 
tion  is  most  active,  the  osseous  system  is  in  the  construc¬ 
tive  stage  and  formative  processes  are  in  operation. 
The  roots  of  the  teeth  are  not  fully  developed  and  are 
more  or  less  loosely  confined  in  the  alveoli.  The 
apical  foramina  are  large,  which  lessens  liability  of 
blood  supply,  impairment,  and  consequent  destruction 
of  the  pulp. 

Q.  What  are  the  chances  of  good  results  after  that 
period? 

A.  Chances  of  success  in  regulating  decrease 
yearly  after  puberty  and  after  twenty-six  are  very 
meager.  In  a  majority  of  cases,  the  osseous  system 
is  fully  developed  at  this  period. 


ON  IRREGULARITIES  OF  THE  TEETH. 


273 


Q.  Is  it  possible  to  regulate  deformities  as  late  as 
the  thirtieth  year? 

A.  It  sometimes  can  be  done.  The  resulting  pain 
is,  however,  so  severe  and  the  mechanical  force  neces¬ 
sary  to  produce  absorption  of  the  alveoli  so  great  that 
the  results  hardly  justify  the  procedure. 

O.  When  regulated  so  late  in  life,  is  ossific  material 

O  7 

easily  deposited  to  hold  the  teeth? 

A.  It  is  not.  Corrective  plates  must  be  worn 
sometimes  for  years  before  they  become  strong. 

Q.  When  teeth  are  regulated  late  in  life,  especially 
when  extensive  operations  are  performed,  is  there 
ever  a  compensating  ossific  deposit? 

A.  In  such  cases  the  inflammatory  process  is 
almost  never  restored.  Chronic  inflammation  of  the 
alveolar  process  and  peridental  membrane  (a  veritable 
interstitial  gingivitis)  sets  in  with  excessive  absorp¬ 
tion  of  the  alveolar  process  and  gum  contraction. 

Q.  What  precaution  should  be  taken  if  teeth  must 
be  regulated  late? 

A.  The  patient  should  be  impressed  with  a  doubt¬ 
ful  prognosis.  It  must  be  remembered  that  the 
alveolar  process  is  a  transitory  structure.  It  is  simply 
to  hold  the  teeth  in  place.  It  is  removed  when  the 
teeth  are  extracted  or  from  too  violent  irritation 
(auto-intoxication  or  senile  absorption).  Hence  the 
older  the  patient  the  less  liable  to  restoration. 

Q.  What  should  be  done  if  the  patient  insist? 

A.  The  patient  must  assume  the  responsibility  of 
failure. 

Q.  How  does  the  process  of  repair  after  regulation 
differ  from  repair  of  frac:ure? 

A.  In  the  osseous  system  two  parts  of  homogene- 

M  — 


274- 


quiz  COMPEND 


ous  structure  are  united.  In  repair  of  regulation,  the 
tooth  root,  a  dense  structure,  is  enclosed  in  a  spongy 
structure,  the  alveolus.  There  is  no  bony  union. 

Q.  Is  alveolar  nutrition  very  active? 

A.  It  is  during  first  and  second  dentition  until  the 
roots  are  perfectly  formed  or  until  the  final  growth  of 
the  alveolar  process. 

O.  What  happens  afterward? 

A.  The  blood  supply  being  less,  waste  and  repair 
do  not  go  on  so  rapidly  when  the  alveolar  process  is 
injured. 

Q.  How  is  lowered  nutrition  sometimes  shown? 

A.  In  the  separation  of  the  teeth  and  recession  of 
the  alveolar  process  and  gums  in  rapid  wedging,  as 
well  as  in  interstitial  gingivitis. 

Q.  What  illustrates  the  difference  between  fracture 
in  bone  and  tooth  movement? 

A.  The  fact  that  the  attachment  of  a  tooth  to  the 
alveolus  later  in  life  cannot  be  compared  to  the  union 
of  a  fractured  bone  is  evident  in  the  aptitude  of  teeth 
when  regulated  to  return  to  their  original  place. 

O.  Is  new  tissue  as  strong  as  the  original? 

A.  Unlike  bone  and  cicatricial  tissue  it  is  not  as 
strong  as  the  original. 

O.  In  undertaking  regulation  should  the  general 
health  be  taken  into  consideration? 

A.  It  should;  as  the  majority  of  cases  are  in  youth, 
the  state  of  general  health  is  of  no  slight  importance. 
The  most  favorable  period  for  operation  is  unfortun¬ 
ately  one  of  the  most  critical  in  the  life  of  the  patient. 

O.  What  are  the  dangers? 

A.  From  the  age  of  twelve,  the  beginning  of  one 
of  the  most  important  periods  of  stress,  the  rapidly 


ON  IRREGULARITIES  OF  THE  TEETH. 


275 


growing  boy  or  girl  is  subject  to  many  marked  phys¬ 
ical  changes  entailing  profound  disturbances  of  the 
tropho-nervous  system. 

O.  What  other  conditions  are  liable  to  cause  dis- 
turbance? 

A.  Prolonged  and  injudicious  worry,  over  study, 
over  exertion,  impure  air,  improper  food,  sexual  irri¬ 
tation,  auto-intoxication,  as  well  as  other  disturbing 
factors  tend  to  become  prominent  in  the  life  of  the 
individual. 

Q.  What  is  the  strongest  factor  at  this  period? 

A.  Sexual  disturbance  is  of  special  importance  on 
account  of  the  periods  of  stress.  When  to  physiologic 
perturbation  of  this  important  period  of  evolution  are 
added  influence  of  environment,  perversions  of  nutri¬ 
tion  like  rachitis  and  allied  states  consequent  upon 
congenital  weakness,  improper  dietetics,  hereditary 
syphilis  or  the  exanthemata,  the  necessity  of  taking 
into  account  the  influence  of  the  general  health  upon 
operative  procedure  is  self  evident. 

O.  Under  such  conditions  what  is  best  to  do? 

A.  Operations  upon  young  persons  in  delicate 
health  should  not  be  done  until  the  constitution  has 
improved. 

Q.  Should,  the  dentist  be  able  to  recognize  these 
conditions? 

A.  He  should  possess  a  general  knowledge  of  med¬ 
icine  so  that  he  can  recognize  any  physical  defect  and 
have  it  properly  treated. 

O.-  What  is  the  general  condition  of  all  children 
who  require  this  kind  of  treatment? 

A.  They  are  children  with  unstable  nervous  sys- 


270 


QUIZ  COM  PEND 


terns  and  whose  physical  development  is  a  departure 
from  the  normal. 

O.  What  are  some  of  the  disturbances? 

A.  The  mucous  membranes  are  badly  developed, 
especially  bowels,  rectum,  and  other  mucous  tracts. 
The  digestive  and  assimilative  functions  are  faulty. 
The  glandular  system  is  weak.  The  excreta  are  not 
properly  eliminated.  From  an  undeveloped  nervous 
system,  strain  at  this  period  is  often  attended  with 
disastrous  results. 

Q.  What  is  the  process  of  absorption? 

A.  It  was  thought  that  when  mild  pressure  was 
applied  this  was  physiologic,  now  it  is  known  to  be 
pathologic. 

Q.  Explain  this. 

A.  When  pressure  is  applied,  irritation  and  pressure 
set  up  inflammation  which  is  interstitial  in  character. 
Inflammation  causes  deposition  Of  lime  salts  just  as  it 
does  in  fracture. 

Q.  What  effect  do  extensive  operations  or  rapid 
movement  of  the  teeth  have  upon  the  alveolar  process? 

A.  Not  infrequently  in  such  patients  later  in  life  it 
is  found  that  the  alveolar  process  is  not  restored. 
Interstitial  gingivitis  sets  in  early,  the  trabeculae  are 
destroyed, the  teeth  loosen,  separate  or  crowd  together, 
elongate  and  are  finally  lost. 

Q.  What  is  the  character  of  the  patient  who  usually 
requires  dental  regulation? 

A.  They  are  generally  neuropaths  and  degenerates. 
This  increases  the  danger  from  careless  procedure. 

Q.  How  should  the  patient  be  treated? 

A.  His  assimilation  must  be  normal.  He  must 
have  enough  unstimulating  food  to  suit  the  particu- 


ON  IRREGULARITIES  OF  THE  TEETH. 


277 


lar  case.  He  should  have  abundance  of  sleep  in  a 
well-ventilated  room.  He  should  be  in  the  open  air 
as  much  as  possible.  The  mind  should  be  placid  and 
agreeably  occupied  so  as  to  aid  him  to  forget  the  irri¬ 
tation  during  the  process. 

Q.  Does  irritation  with  absence  of  pain  affect  the  • 
nervous  system? 

A.  It  does.  Irritation  without  physiologic  re¬ 
sponse  is  a  greater  tax  on  the  nervous  system  than 
pain  itself. 

O.  Should  dentists  therefore  be  satisfied  that  every¬ 
thing  is  going  well  if  the  patient  does  not  complain? 

A.  They  should  not.  They  should  encourage  the 
patient  to  give  expression  to  his  feelings.  This  aids 
in  deciding  the  time  required  for  each  step. 

Q.  Should  the  patient  go  to  school  while  under 
treatment? 

A.  This  will  depend  upon  the  patient.  School 
strain  to  some  children  is  a  tax  in  itself.  Therefore, 
it  may  be  necessary  to  take  the  patient  out  of  school 
or  to  diminish  his  task.  Schools  are  badly  ventilated. 
Exercise  during  school  hours  is  almost  impossible. 

Q.  Is  not  school-room  discipline  detrimental  to 
some  children? 

A.  Routine  discipline  of  the  school-room  added  to 
strain  of  regulation  is  detrimental  to  health  and 
spirits  when  multiplied  by  the  other  cares  of  puberty 
and  adolescence. 

O.  Is  not  the  mind  in  a  morbid  state  during 
puberty? 

A.  Children  during  puberty  and  adolescence  are 
morbidly  conscientious,  ambitious,  and  reserved. 
They  suffer  much  and  say  little.  This  is  particularly 


278 


QUIZ  COMPEND 


true  of  girls  who  do  not  find  the  relief  boys  do  in  out- 
door  play. 

Q.  Is  not  more  care  required  of  girls? 

A.  Her  life  is  more  circumscribed  and  she  is  more 
liable  to  passive  suffering. 

O.  Should  co-operation  of  a  skillful  physician  be 
secured  as  to  the  general  welfare  and  as  a  share  of  the 
responsibility? 

A.  Yes.  Cases  occur  where  girls  are  invalided  for 
years  solely  by  shock  to  a  primarily  unstable  nervous 
system  from  prolonged  operations  in  regulation. 

Q.  TV  hat  should  be  done  before  such  an  operation? 
A.  I  he  patient  should  be  weighed  at  the  time  the 
appliances  are  adjusted  and  noted  every  two  weeks 
throughout  the  operation. 

Q.  What  is  necessary  on  the  part  of  the  oper¬ 
ator?  L 

A.  Knowledge  of  human  nature,  quick,  judicious 
sympathy,  an  agreeable  presence  and  tact  are  very 
essential.  If  the  dentist  work  in  harmony  with  the 
laws  of  mental  and  physical  health,  half  is  gained. 

Q.  Are  people  anxious  to  have  their  teeth  reo-. 
ulated?  s 

A.  This  depends  somewhat  upon  the  social  status 
of  the  patient,  sex,  and  age.  People  not  well-to-do 
open  if  they  have  a  decided  aesthetic  sense  are  so 
hampered  with  pecuniary  consideration  of  a  more 

ui  gent  nature  that  little  attention  is  paid  to  irregu¬ 
larity.  & 

Q.  How  do  those  in  better  circumstances  look  upon 
such  operations? 

A-  Life  assumes  large  proportions.  Their  lot  in 
life  may  be  materially  changed  by  an  attractive  mouth. 


1  I 

ON  IRREGULARITIES  OF  THE  TEETH.  279 

Beauty  is  of  the  greatest  importance.  Society  taking 
these  things  for  granted  acts  upon  them. 

Q.  Are  operations  more  likely  to  be  performed 
upon  the  well- to  do  than  upon  the  poorer? 

A.  Such  children  seek  the  dentist  for  relief 
Mothers  usually  are  alive  to  the  appearance  of  their 
children  and  encourage  them  to  endure  the  strain. 

Q.  Are  parents  likely  to  hinder  results  by  indiffer¬ 
ence  or  careless  remarks? 

A.  Frequently  they  do  not  co-operate  by  enforcing 
wearing  of  appliances  and  regular  visits.  The  dentist 
should  determine  the  attitude  of  parents  before  his 
task  is  undertaken  since  without  their  co-operation  his 
best  efforts  will  be  thwarted  and  his  reputation  suffer. 

Q.  What  is  the  first  step  in  regulation? 

A.  Taking  the  impression  of  the  mouth. 

.  Q.  Why? 

A.  The  position  of  the  teeth,  their  relation  to  one 
another  and  the  conformation  of  the  jaws  can  be  more 
easily  studied,  and  an  accurate  conclusion  more  readily 
deduced. 

Q.  What  is  necessary  in  such  operations? 

A.  Teeth  should  not  only  be  moved  to  their  proper 
places  but  must  be  in  harmonious  relation  to  one 
another. 

Q.  What  occurs  if  they  be  not  in  harmony? 

A.  They  tend  to  return  to  their  faulty  position. 
Their  normal  relation  can  best  be  determined  by 
•studying  the  model. 

Q.  What  material  should  be  employed  in  taking 
impressions? 

A.  The  material  depends  upon  the  shape  of  the 
jaws  and  position  of  the  teeth;  if  the  teeth  are  but 


280 


QUIZ  COMPEND 


slightly  irregular  and  the  crowns  short,  plaster  of 
Paris  should  be  used.  On  the  other  hand,  if  the  teeth 
are  irregular  and  long  and  the  arch  deep,  plaster  of 
Paris  will  be  likely  to  adhere  to  the  teeth.  In  such 
cases  modeling  compound  should  be  used. 

Q.  How  should  the  patient  sit  to  have  an  impres¬ 
sion  taken? 

A.  He  should  sit  low  in  the  operating  chair  or  in 
an  ordinary  chair.  The  operator  can  thus  better  con¬ 
trol  the  patient. 

Q.  Plow  should  the  clothing  of  the  patient  be  pro¬ 
tected? 

A.  By  placing  two  towels  under  the  chin,  one  fas¬ 
tened  to  the  clothing,  the  other  loose,  and  a  newspaper 
in  the  lap. 

O.  How  should  the  impression  cup  be  prepared? 

A.  One  should  be  selected  large  enough  to  enclose 
the  teeth.  This  should  be  built  up  with  wax  so  that  it 
will  extend  beyond  the  margin  of  the  gum.  The  cen¬ 
ter  of  the  cup  should  be  filled  with  soft  wax  to  conform 
to  the  vault.  In  this  way  the  plaster  will  be  carried 
to  all  parts  of  the  mouth. 

Q.  What  is  the  next  step? 

A.  Plaster  should  be  mixed  in  a  bowl  with  suffic¬ 
ient  water  to  make  mixture  of  the  consistency  of 
cream;  add  a  little  salt  to  hasten  the  process  of  set¬ 
ting.  After  stirring  until  the  air  bubbles  have  disap¬ 
peared  and  the  plaster  has  begun  to  set,  the  cup  and 
outer  edge  should  be  fiPed. 

Q.  How  should  this  oe  applied  to  the  mouth? 

A.  The  operator  should  stand  to  the  right  and  just 
behind  the  patient  wi  h  his  left  arm  around  the  left 
side  of  the  head  and  the  fore  finger  inserted  into  the 


ON  IRREGULARITIES  OF  THE  TEETH, 


281 


mouth.  The  cup  should  be  carried  to  the  mouth  with 
the  thumb  and  fore  finger  upon  the  handle  and  the 
middle  finger  in  the  center  to  steady  it.  After  it  has 
been  inserted  into  the  mouth  with  a  rotary  motion  of 
the  right  hand  it  should  be  pressed  up  into  place  with 
the  middle  finger.  At  the  same  time  the  lips  should 
be  raised,  the  cheek  pressed  out  with  the  left  fingers. 
When  the  cup  is  in  position  it  should  be  held  firmly 
with  the  middle  finger  in  the  center  of  the  plate  against 
the  teeth.  The  head  should  be  inclined  toward  the 
breast  to  prevent  the  plaster’s  passing  back  to  the 
fauces. 

O.  What  is  to  be  done  if  the  stomach  become  dis- 

turbed? 

A.  By  holding  the  fingers  in  the  center  of  the  cup 
as  suggested,  the  contents  of  the  stomach  can  be 
evacuated  without  interfering  with  the  impression. 

0.  When  is  the  impression  ready  to  be  removed? 

A.  Test  the  plaster  in  the  bowl  or  upon  the  side 
of  the  cup;  when  it  breaks  with  a  clean  fracture,  it  is 
time  to  remove  the  cup. 

Q.  What  should  be  done  with  it? 

A.  It  should  be  placed  in  the  outer  towel  held  by 
the  assistant.  Carefully  examine  the  mouth  and  if 
pieces  of  plaster  are  seen,  put  them  into  the  towel  on 
the  proper  side  of  the  impression,  afterwards  arrang¬ 
ing  the  pieces  in  the  proper  places. 

Q.  What  is  the  second  towel  for? 

A.  It  is  for  the  purpose  of  removing  plaster  that 
may  remain  about  the  face. 

Q.  Should  the  operation  be  explained  to  the  patient? 

A.  It  is  well  so  to  do.  Otherwise  the  patient 
might  anticipate  serious  experience. 


282 


QUIZ  COMPEND 


Q.  Are  such  details  necessary? 

A.  The  slightest  detail  should  be  so  strictly  attended 
to  as  to  insure  perfect  impressions. 

Q.  In  taking  an  impression  of  the  lower  jaw,  how 
should  the  patient  sit? 

A.  He  should  sit  higher  so  that  the  mouth  will  be 
on  a  level  with  the  elbow  of  the  operator  who  stands  in 
front  of  the  patient. 

O.  How  is  the  tray  for  the  lower  jaw  manipulated? 

A.  The  fingers  of  the  left  hand  should  push  out  the 
cheek  and  lips  while  the  cup  is  rotated  into  place  with 
the  right  hand.  The  first  and  second  fingers  of  each 
hand  should  rest  upon  the  cup  over  the  bicuspids  and 
molars,  the  thumbs  under  the  jaw  on  either  side,  thus 
holding  the  cup  firmly  in  place  until  the  plaster  sets, 
which  should  be  removed  and  placed  in  the  towel  as 
before. 

O.  What  is  the  next  procedure? 

A.  After  a  few  minutes’  hardening  the  impression 
should  be  placed  under  running  water  to  remove 
mucus,  saliva,  blood,  or  particles  of  plaster.  Should 
the  plaster  be  broken  the  pieces  can  be  placed  in  posi¬ 
tion  indicated  by  the  arrangement  on  the  towel,  and 
when  perfectly  dry  fastened  together  with  melted 
wax. 

Q.  How  is  the  model  separated  from  the  impression? 

A.  A  clean  separation  of  the  model  is  obtained  by 
covering  the  impression  with  a  lather  of  soap  and 
washing  off  the  surplus,  or  by  coating  the  surface  with 
shellac  and  oiling  to  prevent  sticking. 

Q.  How  is  modeling  compound  used? 

A.  Place  boiling  water  in  a  bowl  and  dip  the  com¬ 
pound  into  it  until  it  is  soft  enough  to  use. 


ON  IRREGULARITIES  OF  THE  TEETH, 


283 


O.  How  should  it  be  applied? 

A.  Place  a  sufficient  quantity  into  the  impression 
cup  and  proceed  as  with  plaster,  cooling  it  off  with 
cold  water  applied  with  a  napkin. 

Q.  How  are  the  models  obtained? 

A.  Mix  the  plaster  the  consistency  of  cream.  Place 
a  few  drops  of  water  in  the  cavities  made  by  the  teeth 
to  exclude  the  air,  when  the  plaster  is  introduced  tap 
the  cup  on  the  bench,  thus  driving  out  all  the  air,  build 
up  the  plaster  to  make  •  body  for  the  model.  Such 
models  had  better  stand  from  twelve  to  twenty-four 
hours  so  that  they  may  be  perfectly  hardened. 

Q.  What  should  be  done  with  them  after  removal? 

A.  Trim  the  model  roughly.  After  articulation 
trim  it  so  that  the  body  of  the  model  will  be  parallel 
with  the  line  of  the  teeth  and  made  presentable  for 
inspection. 

O.  How  should  the  models  be  marked? 

A.  Place  the  name  of  the  patient  and  the  date  of 
beginning  operation  upon  the  surface  of  the  lower 
model  and  the  patient’s  initials  upon  the  upper.  The 
surface  should  now  be  varnished;  an  elastic  band  will 
hold  them  together. 

O.  Could  they  not  be  placed  upon  the  articul¬ 
ator? 

A.  A  wire  articulator  may  be  used  to  a  good 
advantage  at  little  expense. 

Q.  What  should  be  done  with  the  models? 

A.  They  should  be  placed  conveniently  so  as  to 
improve  spare  moments  by  studying  physiologic  con¬ 
ditions  of  the  teeth  before  arriving  at  conclusions  as  to 
the  pathology  of  the  case. 

Q.  What  is  necessary? 


284 


QUIZ  COMPEND 


A.  In  determining  the  character  and  extent  of  a 
deformity  a  criterion  is  necessary. 

Q.  How  would  a  standard  be  obtained? 

A.  In  the  skull  on  taking  the  two  cuspids  for  a  start- 
ing  point,  the  arc  of  a  circle  is  found  on  dropping  a  line 
from  one  cusp  of  the  cuspid  to  the  center  of  the  third 
molar,  the  posterior  part  is  seen  to  diverge  consider¬ 
ably  from  the  central  line.  The  inferior  incisor  should 
close  inside  of  the  superior  incisor.  The  buccal  cusps 
of  the  bicuspids  and  molars  should  occlude  at  the  cen¬ 
ter  line  or  suici  of  the  superior  bicuspid  and  molar. 

O.  What  should  be  the  curve  of  the  teeth  from  the 
side? 

A.  It  should  be  a  gentle  curve  downwards  from 
the  cuspid  to  the  second  bicuspid  rising  until  the  third 
molars  are  reached. 

Q.  How  should  the  teeth  lock? 

A.  The  superior  cuspid  should  stand  at  the  point  of 

occlusion  of  the  inferior  cuspid  and  first  bicuspid.  If 
the  teeth  are  all  in  position,  each  tooth  will  lock 
between  two  teeth  of  the  opposite  jaw.  The  median 
line  of  the  upper  incisors  should  correspond  with  the 
median  line  of  the  lower  incisors. 

Q.  What  is  to  be  done  if  the  irregularity  is  compli¬ 
cated  and  more  room  is  required? 

A.  It  is  best  *to  enlarge  the  arch.  The  changing 
of  a  well  articulated  set  of  teeth  so  that  the  cusps  of 
the  opposite  will  strike  is  an  unpardonable  error. 

Q.  What  should  be  the  size  of  the  arch? 

A.  The  arch  of  the  superior  and  inferior  maxilla 
should  have  a  diameter  of  sufficient  width  to  prevent 
an  impression  of  the  teeth  on  the  sides  of  the  tongue 
or  as  large  as  the  jaws  will  admit.  Any  deviation  of 


ON  IRREGULARITIES  OF  THE  TEETH. 


285 


the  jaws  and  teeth  from  this  outline  is  a  deformity 
which  should  receive  the  attention  of  the  dentist. 

Q.  What  do  the  models  reveal  with  this  standard 
in  mind? 

A.  Careful  consideration  shows,  that  one  of  two 
conditions  exists,  either  the  teeth  are  in  a  crowded 
and  irregular  condition  inside  of  the  proper  line  or 
they  are  isolated  and  irregular  outside. 

Q.  What  teeth  are  almost  always  involved? 

A.  In  a  majority  the  irregularity  involves  the  teeth 
anterior  to  the  first  permanent  molar. 

Q.  What  arises  under  such  conditions? 

A.  Whether  to  enlarge  the  arch  by  force  or  to 
extract  one  or  more  teeth. 

Q.  What  will  decide  this? 

A.  The  age  of  the  patient. 

Q.  If  the  temporary  teeth  are  in  the  mouth  causing 
the  irregularities  what  should  be  done? 

A.  They  should  be  removed. 

Q.  When  the  removal  of  the  second  teeth  becomes 
a  necessity  which  tooth  should  be  sacrificed? 

A.  A  tooth  should  be  selected  which  is  the  least 
prominent  or  which  will  least  affect  the  expression. 
In  selecting  teeth  for  removal  each  case  must  be  taken 
as  a  law  unto  itself  requiring  its  own  special  treatment. 

Q.  What  is  generally  practicable? 

A.  A  good  rule  is  to  retain,  if  possible,  the  six 
anterior  teeth;  as  the  cuspids  on  the  upper  jaw  are  the 
most  prominent  and  give  expression  to  the  face,  they 
should  not  be  removed.  If  a  tooth  must  be  sacrificed, 
the  selection  lies  between  the  first  or  second  bicuspid 
and  the  first  molar. 

O.  How  should  the  teeth  be  removed,  if  at  all? 


286 


QUIZ  COMPEND 


A.  If  the  bicuspids  be  decayed  they  should  be 
removed.  If  a  first  molar  be  decayed  and  it  can  be 
crowned,  it  should  not  be  removed.  The  removal  of 
a  first  molar  will  secure  ’more  room  than  is  required. 
It  has  served  from'  the  sixth  year,  which  fact — in  con¬ 
nection  with  its  solidity  in  the  jaws  and  its  central 
position,  argues  for  its  keeping. 

Q.  Should  the  incisors  ever  be  extracted? 

A.  It  occasionally  happens  that  the  articulation 
posterior  to  the  cuspids  is  perfect,  nearly  approximat¬ 
ing  the  central  and  the  laterals  locked  inside  or  out¬ 
side  of  the  arch,  whether  sound  or  decayed,  it  may  be 
best  in  such  cases  to  remove  one  or  both  laterals. 

Q.  Will  the  general  appearance  be  injured? 

A.  It  will  not. 

Q.  Are  the  inferior  incisors  ever  irregular? 

A.  Yes.  If  the  articulation  be  normal  in  the  pos¬ 
terior  part  of  the  mouth  almost  any  of  the  incisors  that 
are  out  of  position  may  be  removed. 

Q.  Do  they  resemble  each  other? 

A.  They  resemble  each  other  so  evenly  in  size  and 
shape  and  are  so  nearly  concealed  by  the  lip  their  loss 
will  not  be  observed. 

Q.  Is  it  necessary  to  be  careful  in  selection  of  the 
teeth  and  mode  of  treatment  in  such  cases? 

A.  Yes.  Since  an  actual  increase  of  the  deformity 
may  be  produced  by  a  hurried  operation. 

Q.  May  the  cuspids  be  removed  on  the  lower  jaw? 

A.  If  the  arch  is  complete  with  the  cuspids  out  or 
inside  they  may  be  removed  with  excellent  results. 

Q.  Which  bicuspid  should  be  removed  if  necessary? 

A.  The  one  which  is  the  most  decayed,  if  by  so 
doing  the  irregularity  can  be  corrected. 


ON  IRREGULARITIES  OF  THE  TEETH. 


287 


Q.  If  both  bicuspids  be  sound,  which  one  may  be 
removed? 

A.  The  first  one  if  the  anterior  teeth  are  crowded. 
This  makes  room  for  the  cuspid. 

Q.  Is  the  Roentgen  ray  of  value  in  diagnosis  of 
tooth  deformities? 

A.  Nowhere  in  medicine  is  it  of  such  importance. 

Q.  Under  what  conditions  may  it  be  used? 

A.  Delayed  eruption,  early  extraction,  abnormal 
and  broken  roots  of  teeth,  location  and  position  of 
third  molars,  absorption  of  roots  of  teeth  and  of  the 
alveolar  process  and  the  roots  can  be  easily  outlined. 

Q.  What  affect  do  these  conditions  have  upon  the 
teeth? 

A.  They  affect  occlusion  and  impair  mastication. 

Q.  How  are  impacted  and  imbedded  teeth  located? 

A.  By  cutting  down  upon  the  locality  and  explor¬ 
ing  for  missing  teeth.  This  is  easily  done  with  very 
little  pain  to  the  patient. 

Q.  Is  it  easy  to  obtain  skiagraphs  of  the  jaws? 

A.  At  the  present  time  it  is  somewhat  difficult  for 
the  reason  that  the  jaws  cannot  be  kept  quiet. 

Q.  Which  teeth  are  the  easiest? 

A.  The  molars  and  bicuspids. 

Q.  If  the  vault  be  high,  can  better  results  be 
obtained? 

A.  Yes. 

Q.  What  are  some  of  the  various  methods? 

A.  Dr.  Kells’  method  is  as  follows:  A  cast  is  made 
of  the  portion  of  the  mouth  to  be  skiagraphed  and  a 
small  piece  of  modeling  compound  molded  over  the 
crowns  of  the  teeth  thereon. 

A  piece  of  aluminum,  this  metal  being  almost 


288 


QUIZ  COMPEND 


transparent  to  the  rays,  of  about  twenty-six  or  twenty- 
eight  gauge,  is  cut  to  the  desired  size  and  shape  and 
bent  to  fit  the  cast  as  well  as  possible.  This  is  slotted 
along  the  edge  toward  the  crowns  of  the  teeth  and 
thereby  attached  to  the  modeling  compound  above 
referred  to.  This  forms  a  convenient  little  film  holder, 
which  when  placed  in  the  mouth  will  allow  the  patient 
to  close  the  teeth  upon  it  and  thus  hold  it  securely  in 
position,  without  danger  of  its  moving  for  a  much 
longer  time  than  is  necessary  to  take  the  picture. 

The  next  step  is  to  cut  the  plate  or  celluloid  film, 
whichever  is  to  be  used,  to  the  proper  size  and  envelop 
it  neatly  in  black  paper,  gluing  down  all  the  edges 
with  paste  and  securing  it  to  the  plate  holder  by  two 
or  three  small  aluminum  clamps. 

This  is  all  that  is  usually  necessary,  but  if  it  is 
deemed  advisable  to  protect  this  from  moisture,  as  is 
sometimes  the  case,  more  especially  for  lower  teeth, 
then  the  black  envelope  is  covered  with  thin  tin  foil 
or  waterproof  paper  neatly  pasted  down,  care  being 
taken  not  to  have  the  foil,  if  that  is  used,  doubled  upon 
the  side  to  be  exposed.  While  this  may  appear  to  be 
a  long  process,  it  is  quickly  accomplished  and  the 
invariably  satisfactory  results  obtained  warrant  the 
trouble  taken. 

The  patient  is  then  seated  in  a  chair  with  a  photog¬ 
rapher’s  head-rest  to  hold  the  head,  the  Tesla  screen 
should  be  adjusted  in  place,  the  tube  brought  to 
about  ten  or  twelve  inches  from  the  face  and  placed 
so  as  to  throw  the  best  shadow  of  the  parts  upon  the 
film.  The  length  of  exposure  depends  upon  the  thick¬ 
ness  of  the  parts  to  be  penetrated,  the  working  condi¬ 
tion  of  the  apparatus  and  the  distance  of  the  patient 


ON  IRREGULARITIES  OF  THE  TEETH. 


289 


from  the  tube,  the  time  being  proportional  to  the 
square  of  the  distance. 

From  sixty  to  ninety  seconds  are  necessary  for 
ordinary  cases,  ranging  perhaps  up  to  one  hundred 
and  twenty  seconds  for  third  molars  in  heavy  jaws, 
while  twenty  to  forty  seconds  are  sufficient  for  some 
favorable  cases  in  thinner  bones. 

Q.  Give  Dr.  J.  N.  M’Dowell’s  method. 

A.  Dr.  J.  N.  M’Dowell  recommends  the  following 
method:  “In  taking  X-rays  of  the  teeth  it  was  found 
impossible  to  conveniently  cut  glass  sensitive  plates  to 
correctly  fit  the  different  parts  of  the  mouth  without 
the  spoiling  of  many  plates.  To  overcome  this  diffi¬ 
culty,  it  was  necessary  to  have  something  that  could 
be  easily  cut  and  shaped  to  fit  the  mouth  for  each 
occasion  and  at  the  same  time  transmit  light  as  a 
negative  in  making  photographs.  Celluloid  prepared 
with  sensitive  chemicals  has  been  found  to  answer  this 
purpose  best. 

“No  special  preparation  of  the  mouth  in  the  way  of 
washes,  etc.,  is  necessary,  as  the  plate  is  protected  by 
a  covering.  Cut  a  piece  of  cardboard  to  fit  the  part  of 
the  mouth  that  is  to  be  photographed.  In  the  dark 
room  lay  the  cardboard  on  the  sensitive  celluloid  plate 
and  cut  to  the  same  shape.  Figs.  258  and  259,  etc., 
of  the  X-ray  pictures  show  the  original  shape  of  the 
cut  celluloid.  This  is  then  wrapped  in  black  paper  to 
protect  the  plate  from  light  and  the  moisture  of  the 
mouth.  The  head  is  so  placed  as  to  be  immovable  and 
the  sensitive  celluloid  placed  in  the  mouth  directly 
back  of  the  teeth  to  be  taken.  The  usual  time  of 
exposure  is  about  a  minute  with  Crookes’  six-inch  tube. 
This  tube  should  be  stationed  some  six  or  eight  inches 

23 


290 


QUIZ  COMPENU 


above  and  in  front  of  the  teeth  to  be  taken,  in  order 
to  secure  the  outlines  of  the  roots.  If  the  tube  is  held 
directly  opposite  the  teeth  the  roots  are  not  taken,  as 
the  plate  cannot  be  inserted  high  enough,  owing  to 
the  shape  of  the  roof  of  the  mouth.’’ 

Q.  What  is  an  element  in  tooth  regulation? 

A.  The  fee. 

Q.  How  is  this  estimated? 

A.  The  dentist  should  have  so  prepared  himself  that 
he  fully  understands  and  appreciates  the  requirements 
of  any  case  which  he  may  undertake  to  correct.  This 
will  take  much  time  and  anxious  thought,  for  which 
he  should  receive  just  reward. 

Q.  What  condition  of  the  patient  should  be  stud¬ 
ied? 

A.  The  temperament  and  disposition  as  well  as  the 
ossific  condition  of  the  iaws. 

J 

Q.  What  frequently  happens  in  these  cases? 

A.  Mouths  exhibiting  very  similar  deformities  on 
account  of  mental  and  physiologic  idiosyncrasies  and 
differences  in  density  of  tissue  occur  requiring  differ¬ 
ent  treatment  and  length  of  time  to  accomplish  favor¬ 
able  results. 

Q.  Should  there  be  an  understanding  between  the 
patient  and  the  operator  as  to  the  fee  before  com¬ 
mencing  the  operation? 

A.  Yes,  as  correct  an  estimate  should  be  made  as 
possible.  This  is  difficult  to  do,  therefore  maximum 
and  minimum  prices  should  be  given. 

Q.  What  are  some  of  the  difficulties  encountered  in 
regulation? 

A.  One  of  the  greatest  is  to  persuade  the  patient 
to  submit  to  the  annoyance  of  wearing  the  appliance, 


ON  IRREGULARITIES  OF  THE  TEETH. 


291 


secondly  to  impress  upon  the  patient  the  necessity  of 
being  prompt  and  faithful  in  visits  to  the  dentist. 

O.  Do  children  ever  become  discouraged? 

A.  Not  appreciating  the  importance  of  these  oper¬ 
ations,  patients,  especially  children,  frequently  be¬ 
come  discouraged  and  are  anxious  to  abandon  the 
treatment  before  completion. 

Q.  Does  the  parent  often  sympathize  with  the  child? 

A.  They  do,  and  without  regard  for  the  labor  or 
expense  which  the  dentist  has  assumed  or  the  real 
interest  of  the  patient,  abandon  the  operation. 

Q.  What  is  always  a  good  plan? 

A.  In  every  case  the  dentist  should  demand  and 
receive  at  least  one-half  the  proposed  fee  before  the 
work  is  begun.  With  this  money  invested  in  the 
operation  the  parent  will  be  loth  to  allow  the  case  to 
be  abandoned  before  it  is  finished. 

O.  What  is  the  dentist’s  responsibility? 

A.  With  due  regard  to  the  comfort  and  good  of  his 
patient,  the  dentist  should  expedite  his  operation  so 
that  suffering  and  expense  may  be  as  light  as  possible. 
All  should  be  done  with  an  intelligent  understanding 
of  the  physiologic  and  pathologic  condition  under  care. 

Q.  What  is  expected  of  the  patient? 

A.  By  obedience  to  the  dentist’s  instructions  can 
facilitate  the  correction  which  will  of  course  greatly 
reduce  the  expense  of  the  operation. 

O.  Is  it  well  to  go  into  the  details  of  the  operation? 

A.  Here  as  elsewhere  in  surgery,  it  is  better  not  to 
give  too  minute  details  as  to  plans  to  be  followed  and 
the  appliances  used,  since  it  frequently  happens  that 
the  most  carefully  planned  procedure  has  to  be  varied 
during  the  operation. 


292 


QUIZ  COMPEND 

Q.  What  effect  does  this  have  upon  the  patient? 

A.  In  this  case  disappointment  and  dissatisfaction 
may  be  engendered  in  the  mind  of  the  patient  or 
relatives  with  a  suspicion  as  to  the  dentist’s  ability  to 
accomplish  the  results. 


CHAPTER  XXXI. 


PHYSIOLOGIC  AND  PATHOLOGIC  CHANGES. 

Q.  What  elements  of  change  enter  into  the 
alveolar  process? 

A.  Development  and  absorption  in  its  relation  to 
eruption  and  loss  of  the  teeth. 

Q.  What  is  the  function  of  the  process? 

A.  The  process  is  to  support  the  teeth  while  in 
place  and  finally  after  their  removal  it  is  lost. 

Q.  What  should  this  tissue  be  called? 

A.  Transitory.  The  osteoblasts  and  osteoclasts 
are  always  present  to  build  up  or  tear  down  structure 
as  may  be  required,  by  the  exigency  of  environment 

Q.  What  other  factor  increases  the  transitory 
nature  of  the  alveolar  process? 

A.  Evolution  of  the  jaws. 

Q.  Do  these  osteoblasts  and  osteoclasts  act  rap¬ 
idly? 

A.  Their  rapidity  of  action  depends  upon  age  and 
the  condition  of  the  system. 

Q.  When  is  the  most  active  period? 

A.  During  youth. 

O.  What  causes  the  activity? 

A.  The  vascularity  and  want  of  density  of  bone 
structure. 

Q.  What  will  produce  absorption  of  the  process? 

A.  Light  constant  pressure. 

Q.  Are  teeth  constantly  changing  their  positions? 

293 


294 


QUIZ  COMPEND 


A.  Absorption  and  deposition  of  bone  is  going  on 
simultaneously  and  continuously. 

Q.  When  is  this  especially  noticeable? 

A.  At  the  first  eruption  of  the  teeth.  x\gain,  when 
the  first  permanent  molar  has  been  removed  and  the 
second  and  third  molars  have  moved  forward  and 
filled  the  space.  Teeth  that  have  erupted  out  of  their 
position  will  often  find  their  way  back  into  place. 

Q.  Can  the  teeth  be  placed  in  their  proper  posi¬ 
tions  by  mechanical  devices? 

A.  By  removing  obstruction,  regulation  of  malpo¬ 
sition  becomes  simple. 

Q.  Can  absorption  be  hastened? 

A.  Equable  reproduction  and  absorption  will 
depend  upon  the  amount  of  pressure  exerted  and  the 
condition  of  the  individual.  In  cachexiae  disintegra¬ 
tion  is  favored  while  tissue  building  is  retarded. 

O.  In  what  conditions  is  tissue  building  retarded? 

/V  O 

A.  This  notably  occurs  in  auto-intoxication  and 
senile  absorption. 

Q.  What  must  be  taken  into  consideration  in  ap- 
plyi  ng  pressure? 

A.  The  degree  of  pressure  and  the  constitutional 
condition  of  the  patient. 

Q.  How  must  pressure  be  applied? 

A.  It  must  be  evenly  distributed  and  constant, 
pain  will  not  be  experienced  when  once  the  teeth 
begin  to  yield. 

Q.  What  will  happen  if  the  force  be  not  constant? 

A.  When  the  force  is  applied,  removed  and  reap¬ 
plied  spasmodically  pain  necessarily  results. 

Q.  Illustrate  the  two  methods. 

A.  When  teeth  have  been  separated  to  facilitate 


ON  IRREGULARITIES  OF  THE  TEETH. 


295 


the  filling  of  proximate  cavities,  tooth  vibration  due 
to  preparing  the  cavities  and  application  of  gold  pro¬ 
duces  an  intense  pain  relieved  by  inserting  a  wedge  to 
steady  the  teeth,  when  no  pain  will  be  felt. 

Q.  Does  increased  pressure  imply  greater  pain? 

A.  It  does,  especially  when  alveolar  process  hyper¬ 
trophy  is  present. 

Q.  Is  hypertrophy  very  common? 

A.  It  is.  The  operator  must  be  on  the  alert  to 
discover  its  location  at  the  outset  of  the  operation 
because  heavier  appliances  and  unusual  pressure  are 
required  to  produce  bone  absorption. 

Q.  What  should  be  done  in  such  cases? 

A.  Cutting  away  the  alveolar  process  is  always 
indicated. 

Q.  What  effect  does  it  produce? 

A.'  It  relieves  the  strain  upon  the  nervous  system. 

Q.  What  causes  pain? 

A.  The  pressure  of  the  tooth  upon  the  alveolar 
process  sets  up  inflammation.  When  the  pressure  is 
greater  than  the  absorption  pain  results,  or  where  the 
pressure  is  intermittent  pain  ensues. 

Q  What  was  once  supposed  to  be  the  sole  type  of 
bone  absorption? 

A.  Osteoclast  or  lacunar  absorption. 

Q.  To  what  may  bone  absorption  be  due? 

A.  It  may  be  due  to  either  lacunar  or  osteoclast, 
halisteresis,  Volkmann’s  perforating  canal  or  osteoma¬ 
lacia  (or  senile)  absorption. 

Q.  What  is  lacunar  or  osteoclast  absorption? 

A.  Lacunar  or  osteoclast  absorption  depends  on 
large  specialized  cells  which  liquefy  bone  and  are  situ¬ 
ated  in  Howship’s  lacunae. 


296 


QUIZ  COMPEND 


Q.  What  is  halisteresis  absorption? 

A.  Halisteresis  (from  the  Greek  meaning  salt 
deprivation  or  decalcification)  arises  in  irritation  and 
inflammation  in  the  Haversian  canals.  As  the  salts 
are  absorbed,  commencing  at  the  canal  margins  these 
enlarge. 

Q.  To  what  is  Volkmann’s  perforating  canal  ab¬ 
sorption  due? 

A,  To  irritation  and  inflammation  set  up  in  the 
blood  vessels  of  Von  Ebner  causing  absorption  of  the 
bony  walls  which  perforate  the  bone  from  one  part  to 
another. 

Q.  What  is  osteomalacia  or  senile  absorption? 

A.  It  is  called  juvenile  when  it  occurs  during 
pregnancy.  The  senile  type  may  occur  at  any  period 
of  stress.  It  is  a  morbid  decalcification  whose  origin 
is  at  present  unknown.  It  has  been  charged  to  many 
causes;  to  lactic  acid,  to  increased  amount  of  carbonic 
acid  in  the  blood.  According  to  Eisenhart  it  is  due  to 
diminished  alkalinity  of  the  blood.  According  to  Von 
Recklinghausen  it  is  due '  to  irritation  of  the  vascular 
mechanism  of  the  bones.  Talbot  is  of  the  opinion  that 
it  is  due  to  auto-intoxication. 

Q.  How  were  these  different  absorptions  shown  to 
occur  in  regulation  of  teeth? 

A.  By  experiments  made  upon  dogs. 

Q.  How  was  this  done? 

A.  Impressions  of  the  mouth  were  taken  in  mod¬ 
eling  compound.  Models  were  secured  and  caps  of 
German  silver  were  made  for  the  cuspid  teeth.  A 
jackscrew  was  soldered  to  the  caps  with  soft  solder. 

O.  How  were  the  appliances  fastened  to  the  teeth? 

A.  The  dogs  were  securely  fastened  into  a  V-shaped 


ON  IRREGULARITIES  OF  THE  TEETH. 


297 


box  with  cotton  bandages.  When  chloroformed  the 
appliances  were  placed  upon  the  teeth  and  cemented 
into  place. 

Q.  How  was  the  dog  prevented  from  removing 
the  appliance? 

A.  A  muzzle  was  placed  upon  the  head  and  the 
fore  feet  tied  with  cotton  bandages  to  prevent  removal 
of  the  appliances.  The  muzzle  and  bandages  were 
removed  twice  a  day  for  the  purpose  of  feeding. 

O.  How  often  was  the  screw  turned? 

A.  The  screw  was  given  one-fourth,  one-half  and 
one  full  turn  every  day.  The  screws  were  sixty 
threads  to  the  inch.  The  teeth  of  three  dogs  were 
moved  1-240,  1-120  and  1-60  of  an  inch  respectively  per 
day  as  suggested  by  Farrar. 

Q.  How  long  was  the  muzzle  allowed  to  remain? 

A.  At  the  end  of  three  days  the  muzzle  and  leg 
bands  could  be  removed,  the  dogs  having  become 
accustomed  to  the  appliance.  In  the  cases  where  the 
screw  was  turned  one-fourth  and  one-half  per  day,  was 
continued  for  seven  days.  In  those  in  which  the 
screw  was  given  a  full  turn  it  was  continued  for  two 
weeks,  the  object  being  to  set  up  pathologic  changes 
in  the  alveolar  process.  The  dogs  were  killed  at  the 
end  of  the  periods  mentioned. 

Q.  Flow  were  the  jaws  prepared? 

A.  The  jaws  were  placed  in  sixty-five  per  cent, 
alcohol  for  twelve  hours,  then  in  absolute  alcohol  for 
forty-eight  hours.  They  were  then  transferred  to 
five  per  cent,  nitric  acid  and  water.  This  was  changed 
every  two  days  for  a  week  or  until  the  tissues  became 
so  soft  as  to  be  easily  penetrated  by  a  pin.  They 
were  then  placed  in  running  water  to  remove  acid. 


298 


QUIZ  COMPEND 


This  took  from  twelve  to  twenty-four  hours.  The 
tissues  were  then  placed  in  sixty-five  per  cent,  alcohol 
six  hours;  then  in  ninety-five  per  cent,  six  hours,  and 
then  in  absolute  alcohol  twenty-four  hours.  The 
tissues  were  then  imbedded  in  thin  celloidin  twenty- 
four  hours,  then  in  thick  celloidin  twenty-four  hours. 
They  were  then  mounted  on  blocks  of  wood  and  har¬ 
dened  in  eighty  per  cent,  alcohol  from  six  to  twenty- 
four  hours.  The  specimens  were  cut,  stained  in 
haematoxylin,  eosin. 

Q.  What  had  occurred  in  the  cases  when  the 
screw  was  turned  one-fourth  turn? 

A.  The  inflammatory  process  had  commenced 
around  the  Haversian  canals  with  halisteresis  and 
osteoclast  or  lacunar  absorption,  medullary  cavities 
arising  from  absorption  of  the  trabeculae. 

Q.  What  was  the  difference  between  cases  where 
the  screw  was  turned  one-half  turn  each  day  and 
those  turned  only  one-fourth  turn? 

A.  The  results  were  about  the  same,  only  more 
intensified,  round  cell  infiltration  was  quite  marked. 
The  medullary  cavities  are  larger. 

Q.  Were  there  any  marked  changes  in  those  cases 
where  the  teeth  were  given  a  full  turn  in  fourteen  days? 

A.  All  conditions  noticed  in  the  other  slides  were 
prominent.  Volkmann’s  perforating  canals  were 
marked. 

Q.  What  is  the  difference  between  the  absorption 
of  the  alveolar  process  from  movement  of  the  teeth 
and  interstitial  gingivitis? 

A.  The  absorption  is  precisely  the  same. 

Q.  Does  absorption  of  the  alveolar  process  in  the 
eruption  of  the  teeth  differ? 


ON  IRREGULARITIES  OE  THE  TEETH. 


299 


A.  No.  A  young  monkey  died  from  burns.  The 
upper  cuspids  were  erupting.  The  temporary  cuspids 
were  still  in  place.  The  jaws  were  prepared  in  the 
usual  way  for  the  microscope.  The  slides  show  like 
results. 

Q.  If  absorption  of  bone  in  such  conditions  be 
inflammatory,  what  is  the  process  of  absorption  of  the 
alveolar  process  when  the  teeth  are  removed? 

A.  In  moving  the  teeth  of  dogs,  only  the  upper 
jaw  was  used.  Teeth  on  the  lower  were  extracted  to 
note  the  change  in  the  alveolar  process.  The  teeth 
had  been  extracted  seven  days.  Active  round  cell 
inflammation  occurred  in  and  about  the  Haversian 
canals,  osteoclast  absorption,  Volkmann’s  perforating 
canal  absorption  and  absorption  of  the  trabeculae  was 
also  present. 

Q.  What  is  the  common  opinion  as  to  absorption 
of  bone,  especially  in  regulating  teeth? 

A.  That  it  was  osteoclast  or  lacunar  absorption, 
and  that  if  pressure  was  greater  than  the  tissues  could 
stand,  inflammation  set  in  and  absorption  ceased. 

O.  What  do  these  investigations  show? 

A.  Careful  study  of  the  process  of  absorption 
reveals  that  different  results  could  hardly  be  expected 
in  tooth  movement.  The  surroundings  of  the  alveolar 
process  are  the  same  in  all  cases.  Absorption  is  the 
same,  though  the  propelling  forces  be  different — inter¬ 
stitial  gingivitis,  irritation, screw  pressure,  the  eruption 
of  a  tooth  and  the  extraction  of  a  tooth — in  every  case 
the  absorption  takes  place  by  inflammation. 

Q.  In  rotating  teeth,  does  absorption  take  place? 

A.  To  a  slight  extent  inflammation  takes  place. 
The  fibers  elongate  and  take  the  direction  of  the  tooth. 


300 


QUIZ  COMPEND 


Q.  Does  pressure  upon  the  tooth  detach  the  peri¬ 
dental  membrane? 

A.  It  does  not. 

Q.  What  becomes  of  the  fibrous  tissue  when  teeth 
are  moved  in  straight  lines  or  rotated^ 

A.  The  fibers  stretch.  If  pressure  be  removed, 
the  elasticity  of  the  tissues  returns  the  tooth  to  its 
original  position. 

Q.  What  change  occurs  when  a  tooth  has  been 
forced  into  a  new  position? 

A.  The  fibrous  tissue  is  reinforced  by  new  tissue. 
Osteoblasts  build  up  new  bone  and  in  this  way  the 
teeth  are  held  in  their  new  position. 

Q.  If  the  alveolar  process  has  obtained  its  growth 
or  if  the  fibrous  tissue  (trabeculae)  is  destroyed,  what 
are  the  chances  of  restoration? 

A.  They  are  very  slight. 

Q.  In  the  light  of  these  experiments  and  the  ease 
with  which  inflammation  and  absorption  are  produced, 
can  the  alveolar  process  be  bent  in  regulation? 

A.  It  is  doubtful  if  such  a  thing  be  possible.  In 
any  case,  should  the  process  yield  to  pressure,  absorp¬ 
tion  must  continue  until  the  pressure  is  relieved. 

Q.  Is  not  the  continuous  pressure,  producing  in¬ 
flammation  in  children  whose  nervous  systems  are 
unstable,  pernicious  practice? 

A.  It  is  not  good  practice  to  cause  continuous  pain 
for  any  length  of  time  by  forcing  the  teeth  through 
the  alveolar  process  when  it  can  be  accomplished  by 
the  much  more  rapid  scientific  method  of  cutting  away 
the  bone. 

Q.  How  does  osteomalacia  or  senile  absorption 
affect  the  alveolar  process. 


ON  IRREGULARITIES  OF  THE  TEETH. 


301 


A.  While  other  forms  of  absorption  must  await 
the  onset  of  the  inflammatory  process,  osteomalacia  or 
senile  absorption  sooner  or  later  ensues  in  every  indi¬ 
vidual. 

Q.  Why  is  this? 

A.  Instability  of  the  alveolar  process  renders  this 
a  normal  absorption. 

Q.  To  what  is  this  absorption  due? 

A.  It  is  readily  produced  by  slight  irritation  like 
heat,  auto- intoxication,  drugs,  etc.  It  naturally 
occurs  after  the  process  has  obtained  its  growth. 

Q.  When  does  it  occur  at  an  early  period? 

A.  When  pathologic  factors  such  as  malnutrition, 
drugs,  etc.,  suffice  to  overcome  cell  building. 

Q.  Does  the  unstable  nature  of  the  alveolar  pro¬ 
cess  render  interstitial  gingivitis  common? 

A.  It  may  be  found  in  almost  every  mouth,  par¬ 
ticularly  neurotics'and  degenerates. 

Q.  To  correct  irregularities  of  the  teeth,  should 
the  operator  understand  the  laws  of  degeneracy? 

A.  He  should.  Rapidity  in  irregularity  correction 
implies  lack  of  knowledge  of  the  structures  upon  which 
he  operates. 

Q.  Is  it  good  practice  to  move  the  tissues  rapidly? 

A.  No.  If  force  be  so  great  as  to  destroy  the 
trabeculae,  tissue  building  cannot  restore  the  process. 
If  great  but  not  steady  pressure  be  applied,  and  if 
nutriment  be  poor,  the  alveolar  process  will  not  be 
restored. 

Q.  Should  teeth  be  regulated  in  persons  whose 
nutrition  is  poor? 

A.  No.  Malnutrition  of  the  alveolar  process 
should  preclude  operation,  or  if  it  must  be  performed, 


302 


QUIZ  COMPEND 


slow,  steady  pressure  should  be  used  to  prevent 
excessive  interstitial  gingivitis.  Patients  with  scrofu¬ 
lous,  syphilitic  or  tubercular  tendencies  should  be 
treated  with  great  consideration. 

Q.  Should  many  teeth  be  treated  at  a  time  in 
such  cases? 

A.  No;  one  or  two  only. 

Q.  Should  teeth  be  regulated  late  in  life? 

A.  Only  in  emergencies.  The  results  are  in  pro¬ 
portion  to  the  strain  upon  the  system.  The  tendency 
is  toward  osteomalacia,  although  other  forms  of 
absorption  may  occur.  Permanent  absorption  may 
ensue. 

O.  Should  extended  operations  be  performed  late 
in  life? 

A.  No.  Even  if  successful  and  if  the  teeth  be 
retained  in  their  positions,  the  alveolar  process  cannot 
be  depended  upon  to  remain  throughout  life.  The 
older  the  patient,  the  greater  the  pressure  required, 
the  greater  the  amount  of  inflammation  set  up  and  the 
less  chance  of  success. 

Q.  From  the  transitory  nature  of  the  jaws  and  the 
alveolar  processes,  the  density  of  bone  in  hypertrophy, 
the  terminal  structure  and  the  ease  with  which  inflam¬ 
mation  and  absorption  ensue,  when  and  how  is  regula¬ 
tion  of  teeth  justified? 

A.  The  cutting  away  of  the  alveolar  process  will 
relieve  excessive  pressure,  reduce  the  inflammation  to 
a  minimum  and  prevent  extensive  absorption.  Cor¬ 
rection  of  the  teeth  at  all  periods  produces  structural 
change  in  the  alveolar  process,  the  extent  of  this  ever 
remains  a  predisposing  factor  to  interstitial  gingivitis. 


t 


/ 


v 


CHAPTER  XXXII. 


SURGICAL  CORRECTION. 

Q.  What  science  does  surgical  correction  of  deform¬ 
ities  of  the  jaws  resemble  in  its  relation  to  dentistry? 

A.  Orthopedic  surgery. 

Q.  Is  deformity  correction  a  necessary  result  of 
dental  practice? 

A.  It  is  not.  Special  training  is  needed  for  its 
practice. 

Q.  What  is  required? 

A.  The  person  who  practices  surgical  correction  of 
the  jaws  and  teeth  should  have  mechanical  ingenuity, 
be  familiar  with  mechanical  movements,  and  well 
versed  in  pathology;  in  fact,  medically  educated. 

Q.  Can  fixed  systems  of  appliances  be  depended 
upon  for  the  purpose  of  correcting  a  given  line  of 
cases? 

A.  Only  partially. 

Q.  Is  the  claim  that  appliances  rapidly  and  success¬ 
fully  hasten  correction  absolutely  true? 

A.  No.  Centuries  of  experience  in  surgery  have 
demonstrated  that  appliances  must  be  adapted  to  the 
case  and  not  the  case  to  the  appliances. 

Q.  Is  it  expedient  to  keep  certain  parts  on  hand? 

A.  Certain  simple  pieces  may  be  kept  on  hand  to  be 
attached  to  parts  formed  to  the  case,  but  even  these 
must  be  adjusted  to  the  special  case. 

Q.  Is  not  such  teaching  misleading? 


?P3 


304 


QUIZ  COMPEND 


A.  The  victim  of  such  teaching  frequently  fails  in 
his  cases  by  relying  too  much  upon  a  “system”  rather 
than  upon  general  principle. 

Q.  Do  appliances  frequently  have  to  be  changed? 

A.  One  kind  of  appliance  may  be  used  to  start  the 
operation,  but  the  skilled,  unbiased  operator  is  forced 
to  observe  that  a  different  appliance  can  be  used  to  a 
better  advantage,  especially  in  connection  with  one 
already  in  use. 

Q.  Will  a  specialist  who  confines  himself  to  a  sys¬ 
tem  ever  become  a  skilled  operator? 

A.  No. 

Q.  Taking  the  constitution  and  health  into  consid¬ 
eration,  will  one  set  of  appliances  always  answer  in 
similar  cases? 

A.  An  appliance  theoretically  adapted  to  a  given 
case  may  be  wholly  unfit  because  of  the  patient’s 
physical  condition.  An  appliance  suitable  to  one 
period  in  life  will  not  be  to  another. 

Q.  What  is  necessary  to  obtain  the  best  results  as 
to  mechanical  force? 

A.  A  knowledge  of  the  mechanical  forces,  their 
powers  and  limitations  of  ease,  and  the  methods  of 
application. 

Q.  How  do  all  forces  act? 

A.  They  act  either  continuously  like  the  lever  or 
interruptedly  like  the  screw,  but  in  either  case  their 
action  diminishes  with  the  yielding  of  the  tooth. 

Q.  Of  what  modifications  are  all  the  mechanical 
powers?- 

A.  They  are  modifications  of  two  primary  princi¬ 
ples,  the  inclined  plane  and  the  lever.  From  these 
other  forces  are  derived. 


ON  IRREGULARITIES  OE  THE  TEETH. 


305 


Q.  What  are  the  forces? 

A.  The  screw,  the  lever,  the  pulley,  wheel  and 
axle,  the  inclined  plane,  the  wedge,  and  elasticity. 

Q.  Can  all  of  these  forces  be  applied  in  regulation? 

A.  All  of  these  forces  have  their  places  in  the  cor¬ 
rection  of  deformities  of  the  jaws  and  teeth.  Appli¬ 
ances  cannot  be  made  which  do  not  include  one  or  more 
of  these  forces,  and  all  forces  maybe  successfully  used 
in  regulation. 

Q.  How  should  they  be  taught? 

A.  Principles  rather  than  systems.  Each  may  be 
used  to  a  good  advantage  in  given  cases  when  judg¬ 
ment  has  been  employed  in  selection  and  adjustment 
and  in  adopting  the  methods  of  using  them. 

Q.  Having  the  foundation  principles  of  force  and 
its  application  to  the  teeth,  can  the  operator  select  the 
force  necessary? 

A.  With  these  laws  and  their  application  firmly 
fixed  in  mind  the  operator  can  select  the  one  which 
should  properly  be  applied  or  if  more  than  one  is  nec¬ 
essary  can  so  combine  them  as  to  accomplish  the 
desired  result. 

Q.  What  will  aid  in  the  selection  of  appliances? 

A.  The  degree  and  line  of  force. 

O.  What  is  the  object  of  an-appliance? 

A.  Every  appliance  for  regulation  of  the  teeth 
aims  at  the  object  to  exert  pressure  upon  the  teeth  to 
be  moved. 

Q.  Of  what  should  an  appliance  consist? 

A.  An  appliance  for  this  purpose  should  be  small 
as  compatible  with  effectiveness  and  strength.  It 
should  be  so  constructed  it  can  be  applied  inside  of  the 
arch  in  such  a  manner  it  will  not  interfere  with  speech 


306 


QUIZ  COMPEND 


or  mastication,  and  can  be  removed  for  cleansing  as 
far  as  possible.  It  should  give  as  little  annoyance  as 
possible  and  should  not  necessitate  frequent  visits  to 
the  dentist  for  adjustment. 

Q.  What  must  always  be  considered  in  regula¬ 
tion? 

A.  Whether  the  teeth  be  forced  out  or  drawn  in, 
there  must  always  be  considered  a  body  to  be  moved 
(the  tooth)  and  a  fixed  point  of  resistance. 

Q.  Does  the  study  of  the  models  always  determine 
the  amount  of  force  required? 

A.  It  does  not,  although  models  should  be  studied. 
While  a  point  opposite  can  be  chosen  for  anchorage 
of  the  appliance,  this  is  not  always  true.  Each  case  is 
a  problem  in  itself. 

Q.  Which  must  be  the  strongest,  the  point  of  an¬ 
chorage  or  the  point  to  be  moved? 

A.  The  point  of  anchorage  must  offer  greater 
resistance  than  the  point  to  be  moved. 

Q.  Is  it  sometimes  difficult  to  find  such  a  point? 

A.  Yes.  Especially  the  case  when  a  cuspid  is  to 
be  moved. 

Q.  Does  it  happen  that  the  opposite  is  accomplished 
to  what  was  anticipated? 

A.  It  frequently  happens  that  the  dentist  finds  to 
his  chagrin  he  has  moved  his  point  of  resistance 
rather  than  the  tooth.  Constant  vigilance  must  hence 
be  exercised  in  noting  occlusion. 

Q.  While  the  operation  is  under  way,  what  is  a 
good  plan  to  do? 

A.  The  patient  should  be  asked  at  each  sitting,  in 
which  tooth  he  suffers  most  when  the  nut  is  turned,  if 
a  screw  be  used. 


ON  IRREGULARITIES  OF  THE  TEETH. 


307 


Q.  What  is  a  good  practice  when  teeth  to  be  moved 
possess  great  resistance? 

A.  In  moving  teeth  that  afford  great  resistance,  it 
is  often  best  to  loosen  first  by  simple  wedging  with 
orange  wood  or  even  cotton,  proceeding  slowly. 

Q.  What  effect  does  this  have? 

A.  This  causes  inflammation,  then  absorption  of 
the  alveolar  process  around  the  tooth  or  teeth  to  be 
moved,  giving  the  tooth  decided  advantage  over  the 
fixed  point  when  force  is  applied.  Thus  resistance  is 
lessened  and  the  tooth  or  teeth  to  which  the  appli¬ 
ances  are  attached  will  now  afford  greater  resistance 
in  proportion  than  at  first. 

Q.  Is  it  ever  desirable  to  construct  a  plate  or  com¬ 
bine  two  or  more  teeth  for  a  fixed  point? 

A.  This  is  desirable  (i)  where  there  is  not  a  tooth 
conveniently  located  for  attachment,  (2)  where  it  is 
expedient  to  avoid  the  additional  irritation,  (3)  where 
the  mechanism  is  such  as  to  require  it. 

Q.  What  should  be  considered  in  adjusting  the 
appliance  to  the  tooth? 

A.  Its  position  in  the  jaw  should  be  observed  and 
the  inclination  of  the  root  or  roots  must  be  ascertained 
to  decide  whether  they  stand  perpendicularly  in  the 
alveolar  process  or  on  an  incline. 

Q.  Should  obstructions  be  removed? 

A.  Obstructions  should  be  removed  by  extraction 
or  by  lateral  pressure. 

Q.  How  should  the  force  be  applied? 

A.  The  force  should  be  applied  to  the  tooth  to  be 
moved  either  at  right  angles  to  the  long  axis  of  the 
root  or  at  an  angle  of  forty-five  degrees. 

Q.  What  benefit  is  derived  by  this  method? 


308 


QUIZ  COMPEND 


A.  The  tooth  is  prevented  from  rising  from  the 
socket. 

O.  Should  holes  be  drilled  in  the  teeth  for  an- 
chorage? 

A.  Most  cases  can  be  treated  by  securing  a  band  or 
cap  of  thin  gold  or  platinum  to  the  teeth  with  zinc 
oxyphosphate,  in  which  bands  holes  may  be  drilled  or 
hooks  or  loops  or  tubes  soldered  at  any  required  point. 

O.  How  should  the  force  be  applied? 

A.  If  possible  the  force  should  be  uniform  and 
steady,  but  this  while  possible  with  certain  appliances 
like  elastic  bands,  ligatures,  strings  and  the  like,  is 
impossible  with  the  screw. 

Q.  How  do  these. forces  act? 

A.  All  forces  act  either  slowly  and  constantly  like 
the  above,  diminishing  in  their  action  in  proportion  to 
the  yielding  of  the  tooth,  or  else  they  act  by  impulse 
like  the  screw. 

O.  How  much  pressure  should  be  applied? 

A.  The  force  exerted  should  be  enough  to  produce 
inflammation  and  absorption  of  bone.  Too  rapid 
movement  of  the  teeth,  especially  in  patients  over 
twenty  years  of  age,  is  unadvisable.  Extensive 
inflammation  from  extreme  force  required  prevents 
restoration  of  bone. 

Q.  When  great  pressure  is  required,  are  not  the 
appliances  unsightly  and  inconvenient? 

A.  Appliances  adjusted  to  the  head  are  then  so  un¬ 
sightly  and  embarrassing  Hat  the  patient  is  deterred 
from  an  operation  which  could  otherwise  have  been 
undertaken  had  some  method  been  adopted  that  would 
not  detract  from  personal  appearance. 

Q.  When  appliances  are  attached  to  the  molars  for 


ON  IRREGULARITIES  OF  THE  TEETH. 


309 


the  purpose  of  moving  the  cuspids  and  incisors  back¬ 
ward,  do  the  molars  often  move  forward-instead? 

A.  Very  often. 

Q.  What  are  difficult  problems  to  solve? 

A.  How  to  carry  a  cuspid  into  place  that  has 
erupted  in  the  vault  or  an  inferior  cuspid  that  is  out¬ 
side  and  forward  of  its  normal  position  back  into  place. 
The  rotation  of  teeth,  especially  the  incisors  and  cus¬ 
pids.  Movement  of  teeth  through  hypertrophied 
alveolar  process.  Many  other  situations  present 
themselves  other  than  those  mentioned. 

Q.  Are  the  present  methods  scientific? 

A.  The  long,  tedious  methods  of  plowing  through 
the  alveolar  process  regardless  of  the  density  of  bone 
by  absorption  is  pernicious  and  implies  tedious  days, 
weeks  and  months  of  suffering. 

Q.  Should  not  methods  be  employed  which  avert 
strain  upon  the  nervous  system  at  the  periods  of 
■stress? 

A.  The  periods  most  acceptable  for  the  correction 
of  these  deformities  are  at  twelve  to  sixteen  years  of 
age.  This  time  is  the  most  critical  in  the  patient’s 
life.  Nervous  prostration  of  years  standing  may 
result  and  the  patient  be  permanently  injured  by  such 
nerve  strain. 

Q.  How  can  operations  in  these  cases  be  made  easy? 

A.  To  obviate  excessive  pressure  as  well  as  un¬ 
sightly  appliances,  after  the  appliance  has  been 
adjusted  (no  matter  of  what  nature)  and  pressure 
applied,  proceed  as  follows:  Remove  the  alveolar 
process  in  the  line  of  travel  of  the  tooth  to  be  moved, 
leaving  a  small  amount  about  the  tooth  root  holding 
intact  the  peridental  membrane. 


310 


QUIZ  COMPEND 


Q.  How  is  this  accomplished? 

A.  By  using  round,  coarse-cut  engine  burs,  or 
those  which  cut  in  all  directions.  They  can  be  used 
as  drills.  If  a  cuspid  requires  to  be  carried  back¬ 
ward,  extract  the  first  bicuspid  and  adjust  the  appli¬ 
ance.  Then  resting  the  thumb  against  the  cuspid,  cut 
out  the  lingual  and  buccal  V-shaped  plate,  making  a 
concave  surface  of  the  alveolar  process. 

Q.  How  can  the  incisors  be  carried  back? 

A.  Cut  semi-circular  spaces  just  posterior  to  the 
teeth  to  be  moved. 

Q.  What  procedure  is  to  be  adopted  in  carrying  a 
cuspid  into  place  which  has  erupted  in  the  vault? 

A.  Remove  the  alveolar  process  in  the  direction  of 
the  line  of  travel. 

Q.  In  moving  teeth  laterally  by  the  jackscrew  when 
one  tooth  moves  faster  than  the  other,  how  should 
this  be  adjusted? 

A.  To  bring  both  into  their  proper  positions,  cut 
out  the  alveolar  process  in  front  of  the  slowest  moving 
tooth. 

Q.  How  should  a  tooth  be  rotated? 

A.  Cut  a  circular  groove  as  deep  as  possible  around 
the  tooth,  leaving  enough  process  to  hold  the  peri¬ 
dental  membrane  intact.  In  this  manner  teeth  can  be 
moved  rapidly  and  comparatively  without  pain. 

Q.  What  appliance  should  be  used  in  such  opera¬ 
tions? 

A.  The  screw,  by  this  appliance  the  teeth  are  com¬ 
pletely  under  control. 


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